BackgroundKnee osteoarthritis (OA) has been linked to maladaptive plasticity in the brain, which may contribute to chronic pain. Neuromodulatory approaches, such as Transcranial Direct Current Stimulation (tDCS) and Peripheral Electrical Stimulation (PES), have been used therapeutically to counteract brain maladaptive plasticity. However, it is currently unclear whether these neuromodulatory techniques enhance the benefits of exercise when administered together. Therefore, this protocol aims to investigate whether the addition of tDCS combined or not with PES enhances the effects of a land-based strengthening exercise program in patients with knee OA.MethodsPatients with knee OA (n = 80) will undertake a structured exercise program for five consecutive days. In addition, they will be randomized into four subgroups receiving either active anodal tDCS and sham PES (group 1; n = 20), sham tDCS and active PES (group 2, n = 20), sham tDCS and PES (group 3, n = 20), or active tDCS and PES (group 4, n = 20) for 20 min/day for five consecutive days just prior to commencement of the exercise program. The primary outcomes will be subjective pain intensity (VAS) and related function (WOMAC). Secondary outcomes will include quality of life (SF-36), anxiety and depression symptoms (HAD), self-perception of improvement, pressure pain thresholds over the knee, quadriceps strength, and quadriceps electromyographic activity during maximum knee extension voluntary contraction. We will also investigate cortical excitability using transcranial magnetic stimulation. Outcome measures will be assessed at baseline, 1 month after, before any intervention, after 5 days of intervention, and at 1 month post exercise intervention.DiscussionThe motor cortex becomes less responsive in knee OA because of poorly adapted plastic changes, which can impede exercise therapy benefits. Adding tDCS and/or PES may help to counteract those maladaptive plastic changes and improve the benefits of exercises, and the combination of both neuromodulatory techniques must have a higher magnitude of effect. Trial registration: Brazilian Registry on Clinical Trials (ReBEC) – Effects of electrical stimulation over the skull and tight together with exercises for knee OA; protocol number RBR-9D7C7B.Trial registrationID: RBR-9D7C7B. Registered on 29 February 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2332-6) contains supplementary material, which is available to authorized users.

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Introduction: There is evidence that electroacupuncture (EA) acts through the modulation of brain activity, but little is known about its influence on corticospinal excitability of the primary motor cortex (M1). Objective: To investigate the influence of EA parameters on the excitability of M1 in healthy individuals. Methods: A parallel, double blind, randomized controlled trial in healthy subjects, evaluating the influence of an EA intervention on M1 excitability. Participants had a needle inserted at LI4 in the dominant hand and received electrical stimulation of different frequencies (10 or 100 Hz) and amplitude (sensory or motor threshold) for 20 min. In the control group, only a brief (30 s) electrical stimulation was applied. Single and paired pulse transcranial magnetic stimulation coupled with electromyography was applied before and immediately after the EA intervention. Resting motor threshold, motor evoked potential, short intracortical inhibition and intracortical facilitation were measured. Results: EA increased corticospinal excitability of M1 compared to the control group only when administered with a frequency of 100 Hz at the sensory threshold ( p < 0.05). There were no significant changes in the other measures. Conclusion: The results suggest that EA with an intensity level at the sensorial threshold and 100 Hz frequency increases the corticospinal excitability of M1. This effect may be associated with a decrease in the activity of inhibitory intracortical mechanisms. Trial registration number: U1111-1173-1946 (Registro Brasileiro de Ensaios Clínicos; http://www.ensaiosclinicos.gov.br/ )

INTRODUÇÃO: É relevante compreender que as disfunções do assoalho pélvico (DAP) feminino são condições clínicas que acometem um número crescente de mulheres a cada ano, constituindo um problema de saúde pública. DAP podem ter relação com o desequilíbrio entre a sobrecarga tensional dessa musculatura e a diminuição da capacidade desses músculos em suportar o aumento da pressão nessa região, uma vez que essa musculatura deve se contrair durante qualquer atividade que promova o aumento da pressão intra-abdominal favorecendo a manutenção da continência. OBJETIVO: analisar a presença desta sinergia em três voluntárias descrevendo o comportamento da atividade eletromiográfica de músculos localizados no assoalho pélvico e no abdome durante as atividades funcionais: andar, sentar/levantar, segurar peso, agachar, pular e tossir. MATERIAIS E MÉTODOS: Série de três casos, envolvendo voluntárias jovens universitárias nulíparas, sem queixas miccionais. Foi mensurado o registro da atividade eletromiográfica dos músculos do assoalho pélvico e o grupo muscular formado pelo transverso abdominal e oblíquo interno durante as atividades funcionais, utilizando a eletromiografia de superfície. RESULTADOS: O sinal eletromiográfico aumentou em relação ao repouso durante as atividades funcionais de tossir, pular, agachar, sentar/levantar, segurar peso e andar em ambas as musculaturas analisadas. As maiores atividades eletromiográficas foram observadas durante as atividades de pular e agachar, e as menores ao segurar peso, andar e sentar/levantar. CONCLUSÕES: A partir da coleta eletromiográfica dos músculos transverso abdominal/ oblíquo interno e esfíncter anal externo em três voluntárias nulíparas foi possível observar sinergia destas musculaturas durante as atividades funcionais propostas. Estudos que envolvam grupos maiores de voluntárias, são necessários para podermos afirmar as respostas sobre a sinergia entre esses grupos musculares durante as atividades funcionais.

BACKGROUND AND OBJECTIVES: Adverse effects during noninvasive stimulation of the brain are rare events. The objective of this study is to present a patient´s case with an intense headache with autonomic signs after single-pulse transcranial magnetic stimulation. CASE REPORT: A 28-year old female patient, volunteered to participate in a study on the evaluation of motor cortical excitability after the injection of lidocaine in the first dorsal interosseous muscle. The resting motor threshold was estimated at four moments: before the procedure, immediately after the procedure, 30 minutes, and one hour after the procedure. At the end of the experiment, 240 pulses were performed. The participant reported mild-intensity headache that rapidly progressed to severe, left hemicranial headache, the same region where the transcranial magnetic stimulation pulses were applied. In association with the pain, she had nausea, vomiting, photophobia, conjunctival hyperemia, lacrimation, and ipsilateral eyelid edema, requiring emergency care. CONCLUSION: It is possible that supraliminal intensities (>100% of resting motor threshold) in single-pulse transcranial magnetic stimulation may predispose to adverse effects. Other factors such as skull anatomy, electrical impedance, age, gender, cognitive and affective status, use of medications, hormone levels, the concentration of neurotransmitters and receptor expression, genetic factors and the circadian cycle may also be involved. There are no well-established safety models to guide assessment Headache after evaluation with transcranial magnetic stimulation in a healthy participant. Case report Cefaleia após avaliação com estimulação magnética transcraniana em participante saudável. Relato de caso

BACKGROUND AND OBJECTIVES:The manipulation of peripheral neuronal activity can alter the excitability of the primary motor cortex; however, it is not known whether this occurs after intramuscular injections of lidocaine. Therefore, the investigation focused on neurophysiological changes, assessed with transcranial magnetic stimulation, after lidocaine (0.5mL, 2%) injection in the first dorsal interosseous muscle of the dominant hand of healthy individuals. METHODS: Exploratory, double-blind, parallel laboratory study. Twenty-eight healthy subjects (mean age: 29.6 years, 15 women). Measurements with transcranial magnetic stimulation included resting motor threshold, motor evoked potential, intracortical facilitation, and short intracortical inhibition. Lidocaine injection (LID group) was compared to dry needling (DRY group), saline injection (SAL group), and no intervention (CTL group). Participants were randomly placed in each group. Muscle strength and measures of peripheral excitability (rheobase and chronaxie) were also evaluated to detect whether the interventions generated changes in the peripheral neuromuscular excitability. Evaluations were performed over four time points: immediately before and after intervention and 30 and 60 minutes after intervention.

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