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Changes in Cortical Relative Power in Patients Submitted to a Tendon Transfer

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Changes in Cortical Relative Power in Patients Submitted to a Tendon Transfer Arq Neuropsiquiatr 2007;65(3-A):628-632 CHANGES IN CORTICAL RELATIVE POWER IN PATIENTS SUBMITTED TO A TENDON TRANSFER A pre and post surgery study Julio Guilherme Silva1,2, Irocy Guedes Knackfuss3, Cláudio Elidio Portella1, Sergio Machado1,2, Bruna Velasques1,2, Victor Hugo do Vale Bastos1,2, Ricardo de Andrade Queiroz2, Marco Antonio Orsini Neves4, Mariana Pacheco2, Camila Ferreira Vorkapic1, Mauricio Cagy1,2, Roberto Piedade1,2, Pedro Ribeiro1,2 ABSTRACT - The aim of this study is analyze possible modifications in the cerebral cortex, through quanti- tative electroencephalography (qEEG) in patients submitted to a tendon transfer procedure (posterior tib- ialis) by the Srinivasan’s technique. Four subjects (2 men and 2 women), 49.25 age average (SD±21.4) were studied. All subjects have been through surgical procedure due to leprosy and had, at least, two years of drop foot condition. The qEEG measured the electrocortical activity (relative power) between 8 and 25 Hz frequencies pre and post surgery. A paired t test analyzed all data (p≤0,05). The results show significant al- terations in the alpha relative power, electrodes F7 (p=0.01) and F8 (p=0.021). Altogether, based on find- ings of the current literature, we can conclude that the tendon transfer procedure suggests electrocortical alterations sensitive to specific qEEG bands. KEY WORDS: qEEG, tendon transfer, relative power, drop foot, leprosy. Alterações na potência relativa cortical em pacientes submetidos a transferência de tendão: es- tudo pré e pós-cirurgico ReSUMO - O objetivo deste estudo é analisar possíveis modificações no córtex cerebral, através da electren- cefalografia quantitativa (EEGq), em pacientes submetidos a um procedimento de transferência de ten- dão (tibial posterior) pela técnica de Srinivasan. Quatro sujeitos (2 homens e 2 mulheres), com média de idade de 49,25 anos (±21,4 DP) foram estudados. Todos os sujeitos realizaram o procedimento cirúrgico devido a hanseníase e tinham, pelo menos, dois anos de pé caído. O EEGq mediu a atividade electrocorti- cal (potencia relativa) entre freqüências de 8 e 25 Hz, no pré e pós-operatório. Um teste t pareado anali- sou todos os dados (p≤0,05). Os resultados mostram alterações significativas na potência relativa em alfa, nos elétrodos F7 (p=0,01) e F8 (p=0,021). Baseados em recentes achados na literatura, podemos concluir que o procedimento de transferência de tendão sugere alterações eletrocorticais sensíveis às freqüências específicas do EEGq. PALAVRAS-CHAVE: EEGq, transferência tendinosa, potencia relativa, pé caído, hanseníase. The peripheral neuropathy is one of the most im- orthopedics field, one of the procedures for treat- portant consequences of leprosy, because of the my- ing this type of muscular impairment is the tendon elinization and demyelinization reactions that occur transfer3. This surgical procedure objects the rees- in the infection process by the Mycobacterium lep- tablishment of the segment functionality undergo- rae1. Such nervous lesion promotes deficits in the mo- ing paralysis. In the thirties, Ober4 accomplished the tor and sensory systems, especially in hands and feet2. first surgeries for the correction of the paralyzed in- The deformities caused by the muscular unbalance ferior member, through tendinous transfers. When in these corporal segments become a point of study muscular function is impaired by peripheral neurop- for health professionals working with leprosy. In the athy due to leprosy, the tendon transfer procedure 1Laboratory of Brain Mapping and Sensory-Motor Integration, Institute of Psychiatry, Rio de Janeiro RJ, Brazil (IPUB / UFRJ); 2IBBN - Instituto Brasileiro de Biociências Neurais; 3Department of Orthopedics, Medicine School (FM-UFRJ); 4Department of Neurology Universidade Federal Fluminense, Niteroi RJ, Brazil. Received 21 September 2006, received in final form 17 January 2007. Accepted 21 March 2007. Dr. Julio Guilherme Silva - Rua Filgueiras Lima 68 / 104 - 20950-050 Rio de Janeiro RJ - Brasil. E-mail: [email protected] Arq Neuropsiquiatr 2007;65(3-A) 629 most frequently utilized is the one that uses the tib- body temperature, and blood pressure. Subjects were in- ialis posterior muscle. It is also often indicated in the structed not to smoke, drink coffee and caffeine or xan- cases of peroneal nervous lesions, which causes the thine-containing soft drinks, not to ingest alcohol at least for 10 hours before the exam and have at least 8 hours of drop foot. Srinivasan5 has developed the most uti- sleep. Subjects who had suffered previous physiotherapeu- lized posterior tibialis tendon transfer technique. The tic and orthopedical treatment for correction of the drop aim of this procedure is to restore active ankle dorsi- foot were excluded from the study. Other exclusion crite- flexion6. Few investigations observed the re-learning ria were: plantar ulcers and rigid deformities of the foot, of the movements after transfer procedures, espe- motor deficits or use of psychotropic or psychoactive drugs. cially through quantitative electroencephalography The entire experimental protocol was approved by the Re- search Ethic Committee of HUCFF / UFRJ under the number (qEEG) analysis of the possible cortical alterations be- 228/04 with CIC 193/04. tween the pre and post operative times7,8. Some experiments have tried to elucidate the dy- Experimental protocol – Electroencephalographic anal- namics of cortical activity when individuals incorpo- ysis observed the possible modifications in the electrical ac- rate motor procedures9,10. However, such investiga- tivity between the pre and post surgery times. Two signal tions aiming at explaining the neuroplasticity mech- acquisition phases were considered for the development of this experimental design. The pre operative phase con- anisms during the processes of functional recovery sisted of a qEEG of five blocks and ten trials, during which, and motor re-learning of the dorsiflexion are still each subject tried to accomplish a dorsiflexion movement scarce. Particularly in patients submitted to tendon in the paralyzed foot. After the surgical intervention, all transfer for drop foot, as function of leprosy8. Os- subjects were immobilized for 6 weeks. At withdrawal of man et al.11 analyzed the cortical lateralization para- imobilization the subjects were submitted in the same day, digm during imagination of feet movements. During a second qEEG was performed while subjects attempted to make the same movement. At the pre and post surgery the task, subjects had to imagine the hands and feet phases, the electroencephalographic analysis had a total moving randomly. The results showed that the task duration of 20 minutes, 10 minutes with eyes open and 10 of imagining movements was not related to the lat- minutes with closed eyes. The task (dorsiflexion) was done eralization paradigm, although, paradoxically, while in 5 blocks of 10 movements for each condition (open eyes/ imagining feet movements, they observed an activity closed eyes). Pre surgery phase scalp signals were captured increase in somatossensory areas. This suggests that when the investigator requested the subjects to perform the task and post surgery was synchronized by a goniom- imagining and actually elaborating movements pro- 11 eter which marks the qEEG data. Two-minutes of interval duces muscular activity . In EEG studies, alpha and were given between blocks to avoid muscular fatigue. To beta ranges are related to activities in the somatos- mark the beginning of the dorsiflexion movement, it was sensory cortex and novelty learning process. Some in- stipulated that the task would begin after the examiner vestigations have demonstrated the correlation be- touches the lateral part of the subject’s left forearm. All tween the alpha band (8-13 Hz) and cognitive aspects subjects accomplished the dorsiflexion movement at the such as attention while performing or re-learning a maximum of the limit range. Thigh and leg areas were supported in their posterior motor task12,13. The beta range (13-30 Hz) has a di- phases so that the foot was in suspension and the knee ex- rect relationship with motor and somesthesia pro- tended, placing the foot in a neutral position. The goniom- cesses14. For this reason, the aim of this study was to eter was fixed to the ankle, respecting all anatomical points analyze, through qEEG, possible modifications in the for its placement, as follows: the superior arm of the goni- electrocortical activity, specifically in the alpha and ometer placed in the border of the fibula, and the inferior beta bands/ranges, in patients submitted to the tib- one put at the external border of the foot, aligned the di- aphysis of the 5th metatarsus. In the central axis of the goni- ialis posterior tendon transfer. ometer, located laterally on the ankle, a potentiometer was coupled to the EEG device, enabling the observation of the METHOD movement onset. In the experiment, the goniometer simply Sample – Four subjects were selected (2 men and 2 registers the dorsiflexion movement and does not consid- women). They were patients from the service of Orthope- er the degree precision of the articular amplitude. For the dics and Traumatology of the Hospital Universitário Clem- quantification of functional analysis, we adapted the eval- entino Fraga Filho / Universidade Federal do Rio de Janei- uation model of tendon transfers proposed by Yeap15. The ro (HUCFF/UFRJ) with drop foot due to leprosy. All subjects questionnaire was composed of 7 categories with differ-
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