Impacto da ultrapassagem de um obstáculo, da concentração de fator neurotrófico derivado do cérebro e do tratamento com vitamina D na marcha em pessoas com esclerose múltipla
Carregando...
Data
2020-12-10
Autores
Santinelli, Felipe Balistieri
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
A esclerose múltipla (EM) é uma doença neurodegenerativa, inflamatória e autoimune que afeta a bainha de mielina dos neurônios localizados no sistema nervoso central (SNC). Essa desmielinização sofrida pelos neurônios provocam déficits no andar e na atividade cortical, podendo estar relacionada com uma piora do andar, principalmente em ambientes mais complexos. Entretanto, os fatores neurofisiológicos dos déficits do andar nessa população não serem bem conhecidos, podendo a concentração do Fator Neurotrófico Derivado do Cérebro (BDNF) e menor concentração de vitamina D, estarem correlacionados com os parâmetros motores e neurais do andar. Com isso, o objetivo desta dissertação foi investigar o impacto da presença de um obstáculo durante o andar, da concentração de BDNF e da vitamina D na atividade cortical e nos parâmetros espaço-temporais do andar em pessoas com EM. Para responder aos questionamentos da dissertação, três estudos foram propostos. Para o estudo 1, foram recrutadas 15 pessoas com EM e 15 pessoas neurologicamente saudáveis, que realizaram o andar em duas condições: com e sem a presença de um obstáculo de espuma de 15 cm de altura, correspondente a altura do meio-fio, em seu caminho. Os parâmetros espaço-temporais do andar e da atividade cortical adotados foram os mesmos para ambas as condições, exceto para a condição com obstáculo, onde foram calculados as distancias horizontais e verticais, em relação ao obstáculo, de ambos os pés. Os resultados revelaram que as pessoas com EM possuem déficits no andar em ambas as condições (e.g., menor comprimento do passo e menor velocidade do passo) e maior atividade cortical do que os seus pares sem a doença. Essas alterações ficam mais evidenciadas na presença de um obstáculo, além das pessoas com EM posicionar ambos os pés mais próximos ao obstáculo, sendo considerado uma estratégia mais arriscada. Para o estudo 2, 20 pessoas com EM e 18 controles foram recrutados. Coletas sanguíneas foram realizadas para verificação da concentração sanguínea de BDNF. Os participantes andaram somente sem a presença de um obstáculo, sendo obtidos os mesmos parâmetros do andar e da atividade cortical do estudo 1. Além disso, os participantes realizaram o teste de mobilidade funcional (Timed-up-go- TUG). Os resultados indicaram que o comprimento do passo, a velocidade do passo, o TUG e as bandas de frequência teta e beta da atividade cortical do córtex motor, foram correlacionados com a concentração de BDNF. Ainda, a análise da curva ROC indicou que a velocidade do passo, TUG e a banda beta do córtex motor são bons classificadores da EM. Por fim, no estudo 3, 16 pessoas neurologicamente saudáveis e 20 pessoas com EM foram recrutadas, sendo às pessoas com EM divididas em dois grupos: pessoas que suplementavam vitamina D (EMD- 10 indivíduos) e pessoas sem suplementação (EMsD- 10 indivíduos). O mesmo protocolo do estudo 2 foi empregado, sendo mensurado também a concentração sanguínea de vitamina D. O resultado mostrou que apenas o grupo EMsD apresentou deficiências nos parâmetros espaço-temporais do andar (e.g., menor comprimento do passo e menor velocidade do passo) quando comparado com o grupo controle. Apesar de ambos os grupos apresentarem maior atividade cortical do que o grupo controle, o grupo EMsD apresentou maior atividade em todas as regiões analisadas (frontal, motora, parietal e occipital) comparado ao grupo controle. Esses resultados sugerem que a vitamina D pode estar atuando na melhora dos parâmetros motores e neurais do andar em pessoas com EM.
Multiple sclerosis (MS) is a neurodegenerative, inflammatory and autoimmune disease that affects the myelin sheath of neurons located in the central nervous system (CNS). This demyelination suffered by neurons causes deficits in gait and in cortical activity, which may be related to a worsening of walking in a more complex environments (i.e., crossing an obstacle). However, the neurophysiological factors of gait impairments in this population are not well known, the concentration of the Brain Derived Neurotrophic Factor (BDNF) and a lower concentration of vitamin D may be correlated with the motor and neural parameters of the gait. Thereby, the objective of this dissertation was to investigate the impact of the presence of an obstacle, the concentration of BDNF and vitamin D on the cortical activity and the spatial-temporal gait parameters in people with MS during gait. To answer the questions of the dissertation, three studies were proposed, and a total of 40 people participated in the gait evaluations. For study one, 15 people with MS and 15 neurologically healthy people were recruited, which walked in two gait conditions: with and without the presence of a 15 cm high foam obstacle, corresponding to the height of the curb, in their path. The spatial-temporal gait parameters and cortical activity adopted were the same for both conditions, except for the condition with obstacle, where the horizontal and vertical distances were calculated related to the obstacle, of both feet. The results showed that people with MS present gait impairments in both conditions (e.g., lower step length and step velocity) and higher cortical activity than their healthy peers. These changes are more evident in the presence of an obstacle, with the people with MS positioning both feet closer to the obstacle, being considered a riskier strategy. For study two, 20 people with MS and 18 controls were recruited and blood samples were obtained to measure the serum concentration of BDNF. The participants walked only without the presence of an obstacle and the same gait and cortical activity parameters of the study 1 were obtained. In addition, the participants performed the functional mobility test (Timed-up-go- TUG). The results indicated that the step length, the step velocity, TUG and the theta and beta frequency bands of the cortical activity of the motor cortex, were correlated with the BDNF concentration. Still, the ROC curve analysis indicated that the step velocity, TUG and the beta band of the motor cortex are good classifiers of MS. Finally, in study three, 16 neurologically healthy people and 20 people with MS were recruited, with people with MS divided into two groups: people who supplemented vitamin D (MSD-10 individuals) and people without supplementation (MSwD-10 individuals). The same protocol as in study 2 was used and the vitamin D blood concentration was measured. The result showed that only the MSwD group showed gait impairments in the spatial-temporal gait parameters (e.g., lower step length and step velocity) when compared with the control group. Although both groups showed greater cortical activity than the control group, the MSwD group showed greater activity in all regions analyzed (frontal, motor, parietal and occipital) compared to the control group. These results suggest that vitamin D may be acting to improve the motor and neural parameters of gait in people with MS
Multiple sclerosis (MS) is a neurodegenerative, inflammatory and autoimmune disease that affects the myelin sheath of neurons located in the central nervous system (CNS). This demyelination suffered by neurons causes deficits in gait and in cortical activity, which may be related to a worsening of walking in a more complex environments (i.e., crossing an obstacle). However, the neurophysiological factors of gait impairments in this population are not well known, the concentration of the Brain Derived Neurotrophic Factor (BDNF) and a lower concentration of vitamin D may be correlated with the motor and neural parameters of the gait. Thereby, the objective of this dissertation was to investigate the impact of the presence of an obstacle, the concentration of BDNF and vitamin D on the cortical activity and the spatial-temporal gait parameters in people with MS during gait. To answer the questions of the dissertation, three studies were proposed, and a total of 40 people participated in the gait evaluations. For study one, 15 people with MS and 15 neurologically healthy people were recruited, which walked in two gait conditions: with and without the presence of a 15 cm high foam obstacle, corresponding to the height of the curb, in their path. The spatial-temporal gait parameters and cortical activity adopted were the same for both conditions, except for the condition with obstacle, where the horizontal and vertical distances were calculated related to the obstacle, of both feet. The results showed that people with MS present gait impairments in both conditions (e.g., lower step length and step velocity) and higher cortical activity than their healthy peers. These changes are more evident in the presence of an obstacle, with the people with MS positioning both feet closer to the obstacle, being considered a riskier strategy. For study two, 20 people with MS and 18 controls were recruited and blood samples were obtained to measure the serum concentration of BDNF. The participants walked only without the presence of an obstacle and the same gait and cortical activity parameters of the study 1 were obtained. In addition, the participants performed the functional mobility test (Timed-up-go- TUG). The results indicated that the step length, the step velocity, TUG and the theta and beta frequency bands of the cortical activity of the motor cortex, were correlated with the BDNF concentration. Still, the ROC curve analysis indicated that the step velocity, TUG and the beta band of the motor cortex are good classifiers of MS. Finally, in study three, 16 neurologically healthy people and 20 people with MS were recruited, with people with MS divided into two groups: people who supplemented vitamin D (MSD-10 individuals) and people without supplementation (MSwD-10 individuals). The same protocol as in study 2 was used and the vitamin D blood concentration was measured. The result showed that only the MSwD group showed gait impairments in the spatial-temporal gait parameters (e.g., lower step length and step velocity) when compared with the control group. Although both groups showed greater cortical activity than the control group, the MSwD group showed greater activity in all regions analyzed (frontal, motor, parietal and occipital) compared to the control group. These results suggest that vitamin D may be acting to improve the motor and neural parameters of gait in people with MS
Descrição
Palavras-chave
Esclerose Múltipla, Locomoção, Atividade Cortical, Fator Neurotrófico Derivado do Cérebro, Vitamina D, Multiple sclerosi, Gait, Brain Derived Neurotrophic Factor, Electroencephalogram, Vitamin D