- Email: [email protected]
Using transcranial electrical stimulation (TES) motor threshold to potentially determine individual transcranial direct current stimulation (tDCS) dosing
Abstracts / Brain Stimulation 10 (2017) 346e540
Patient was started on the Nemechek Protocol which consists of patientadministered tVNS 2 hours per day (5 Hz, 250 uS, 1 mA) via the tragus, Rifaximin (550 mg BID x 10d) and daily supplementation with 3,000 mg of DHA (fish oil) plus 30 ml of EVOO. Results: After 4 months of treatment, RFa (parasympathetic) and LFa responses remained normal on deep breathing (DB), valsalva (Val) and RFa on orthostatic challenge (OC). The weak LFa response on OC normalized after treatment. The treatment was well tolerated, and the patient’s symptoms resolved.
Spectral Analysis (bpm2) After 4 Months on Therapy
Baseline Treated
Rest
Rest
DB
Val
Val
OC
OC
LFa
RFa
RFa
LFa
RFa
LFa
RFa
7.13 3.41
5.20 7.31
103.6 90.8
142.9 78.9
17.5 17.14
3.5 6.08
1.77 1.02
Conclusion: Incorporation of tVNS in the Nemechek Protocol produces an treatment regimen capable of reversing chronic autonomic dysfunction and symptoms associated with postconcussion syndrome. This simple and inexpensive regimen make is an accessible treatment regimen for reversal of autonomic dysfunction associated with postconcussion syndrome. Keywords: VNS, autonomic, concussion, inflammation [0681] DIFFUSION TENSOR IMAGING EVALUATION OF NEURAL NETWORK DEVELOPMENT IN PATIENTS UNDERGOING THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION FOLLOWING STROKE N. Yamada*1, R. Ueda 3, W. Kakuda 1, R. Momosaki 1, T. Kondo 2, T. Hara 1, A. Senoo 3, M. Abo 1. 1 The Jikei University School of Medicine, Japan; 2 Shimizu Hospital, Japan; 3 Tokyo Metropolitan University, Japan Introduction: Motor function recovery in patients with stroke is considered to be largely due to plastic changes in the cerebral cortex. In the present study, we investigated plastic changes in cerebral white matter structures following a 15-day rehabilitation period using generalized fractional anisotropy (GFA) values. Methods: Thirty-six patients with upper limb hemiparesis due to stroke received a therapeutic protocol comprising 12 sessions of repetitive transcranial magnetic stimulation (rTMS) consisting of 2,400 pulses applied to the non-lesional hemisphere and a 240-min intensive occupational therapy (OT; 40-min one-to-one training for three times and 120-min self-training) daily for 15 days. Motor function was evaluated using the Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT). Patients underwent diffusion-tensor magnetic resonance imaging (MRI) on admission and discharge, from which
Ă
509
bilateral GFA values in Brodmann area (BA) 4 and BA6 were calculated (GFA value range of 0 to 1). Results: All patients completed the 15-day protocol without experiencing any adverse effects. Motor function improved following treatment (p < 0.001). Treatment increased GFA values for lesioned BA4 (p < 0.05) as well as those for non-lesioned BA4 (p < 0.001). The change in GFA value for BA4 of the lesioned hemisphere was significantly inversely correlated with changes in WMFT scores (R2 ¼ 0.363, p < 0.05). Discussion: The application of low-frequency rTMS combined with intensive OT resulted in increased GFA values in BA4, as well as improvements in upper limb hemiparesis, suggesting that the combined rTMS-OT intervention may induce beneficial plastic changes in cerebral white matter structures, though the lack of a control group in the present study limits this interpretation. Serial assessments of GFA values seem to provide reliable evidence of structural changes in cerebral white matter in patients undergoing rehabilitative intervention following hemiparetic stroke, although further studies are required to confirm this finding. Keywords: diffusion tensor imaging, transcranial magnetic stimulation, neural network, generalized fractional anisotropy [0682] EFFECTIVENESS OF RTMS IN DEPRESSION: A BRIEF REPORT M. Pirmoradi*, F. Asadi. Iran University of Medical Science, Iran Introduction: Transcranial magnetic stimulation (TMS) is an important method for noninvasive stimulation of brain in treatment of depression. During the past 10 years, therapeutic effects of repeated Transcranial Magnetic Stimulation (rTMS) have been widely studied in psychiatry and its efficacy has been demonstrated in the treatment of major depressive disorders.In my study,we explored the effectiveness of antidepressant course of rTMS in major depression. I treated four patients with rTMS and constant medication . Methods: Based on SCID and DSM IVTR four depressed patients who reffered to Sobhe Sadeg center treated with rTMS for 15 sessions( three days a week) when he got constant medication.Upon the intervention they were tested with BDI to determine the effect of treatment for five times. Results: Three weeks trial of repetitive transcranial magnetic stimulation in this research showed a good effects in reduced of BDI test . Conclusion: Finding suggest that transcranial magnetic stimulation is a good and searchable device for combination therapy in treatment of major depressive disorders. Keywords: Major depression disorder, Transcranial magnetic stimulation, Antidepressant. [0683] USING TRANSCRANIAL ELECTRICAL STIMULATION (TES) MOTOR THRESHOLD TO POTENTIALLY DETERMINE INDIVIDUAL TRANSCRANIAL DIRECT CURRENT STIMULATION (TDCS) DOSING
510
Abstracts / Brain Stimulation 10 (2017) 346e540
B.W. Badran*, E. Kofmehl, J.J. Borckardt, M. Bikson, C. Mullins, P. Summers, M.S. George. 1 Medical University of South Carolina, USA; 2 The City College of New York, USA; 3 Ralph H. Johnson VA Medical Center, USA Introduction: Researchers have not yet determined a method for individually dosing tDCS. This lack of dosing and titration has likely contributed to the reproducibility and clinical trial difficulties. Using single-pulse transcranial electrical stimulation (TES) thresholds as a surrogate for tDCS, we aimed to determine whether objective recordings (TMS neurophysiology, individual MRI measures and scalp resistance) might determine individual tDCS dosing. Methods: 30 healthy adults (15 female) participated in this two-visit trial. In the first experimental visit, TMS was used to determine left motor hotspot and conventional neurophysiological recordings were acquired (rMT, PPI, CSP, RC). Scalp resistance was then recorded and 5 single-pulses of TES (constant current, PW: 200ms) were administered using tab electrodes (anode e left motor hotspot, cathode e left deltoid). Active right thumb MEPs elicited by TES pulses were recorded using Spike2 and the TES motor threshold was determined using a PEST algorithm similar to TMS rMT. The second visit was an MRI scan in which a structural image was acquired (fiducial over the motor hotspot) from which scalp to cortex distance was recorded. Results: The TES procedure was well tolerated without dropouts (TES threshold marginally more painful than TMS thresholds). A regression analysis was conducted using all objective recordings and a formula for predicting threshold was generated using factors statistically determined to be relevant (gender, TMS rMT, scalp resistance). The following model only accounts for 15% of the variance observed: TES threshold ¼ 43.69 + (6.551 X Sex) + (.507 X rMT) + (-.003 X mU) Discussion: TES is a safe and relatively painless surrogate of tDCS. Of all recordings, only relevant gender, TMS rMT, and scalp resistance were able to predict only 15% of TES variance. TES thresholds are a feasible and effective surrogate method for tDCS and should be explored in refining tDCS methodology. Keywords: tDCS, Dose, transcranial electrical stimulation (TES)
[0687] NEW EEG MEASURES AT THE BEGINNING OF MDD RTMS TREATMENT PREDICT ITS EFFICIENCY: PRELIMINARY RESULTS R. Shani-Hershkovich*1, D. Haor 1,2, A. Amit 1, U. Alyagon 2, D. Shmuel 4, A. Zangen 2, Y. Levkovitz 3, 4, A.B. Geva 1, 2, Z. Peremen 1, 3. 1 ElMindA LTD., Israel; 2 Ben Gurion University, Israel; 3 Tel Aviv University, Israel; 4 Beer-Yaacov Mental Health Center, Israel Background: In recent years, many electroencephalography (EEG)-based predictors for major depressive disorder (MDD) treatment outcomes have been reported. These studies attempted to classify subjects as future responders/non-responders by measures taken before treatment. In this study, we examined a novel EEG measure, ongoing Brain Network Activation (oBNA), acquired during repetitive transcranial magnetic stimulation (rTMS) treatment, as a potential predictor of treatment efficiency. Methods: Eighteen medication-resistant MDD patients received full multiple-site rTMS treatment. The first session included a simultaneous EEG recording. Hamilton Depression Rating Scale (HDRS-17) was measured before the first and last treatment sessions, and the percent of change was calculated. Each treatment contained 1Hz stimulation (right dorsolateral prefrontal cortex; DLPFC) throughout the treatment session, and 20Hz (left DLPFC) 1-second trains, every 15 seconds. 13-second epochs, after each 20Hz stimulation train, were processed through an automatic algorithm that removes EEG artifact. Frequency domain oBNA was calculated for each epoch. A novel inter-trial-difference (ITD) measure that reflects the oBNA difference between the start and the end of a treatment session was evaluated as a predictor. In addition, we evaluated the oBNA scores at different frequency bands as predictors.
Results: (1) oBNA ITD in the low-gamma frequency, across frontal electrodes, was found to be significantly correlated to the %change of HDRS-17 (r¼0.78, p<0.001). (2) Low-gamma and (3) high-beta frequency oBNA also significantly correlated with %change HDRS. The ITD and the low gamma oBNA features were found to be the most predictive measures (PPV/ NPV¼0.79/1 and PPV/NPV¼0.9/0.82, respectively). Summary: Our preliminary results show that all three tested ongoing EEG measures successfully predict rTMS treatment outcomes. We suggest that a combination of several parameters on a larger sample will yield an even more reliable prediction, to serve an accessible objective clinical tool during treatment selection. This study was conducted in collaboration with Brainsway LTD. Keywords: EEG, rTMS, MDD, BNA [0688] OPTIMIZATION OF DEEP BRAIN STIMULATION IN STN AMONG PATIENTS WITH PARKINSON'S DISEASE USING A NOVEL EEG-BASED TOOL D. Sand*1, Z. Peremen 1, 3, D. Haor 1, 2, D. Arkadir 4, H. Bergman 5, A. Geva 1,2. 1 ElMindA Ltd, Israel; 2 Ben Gurion University, Israel; 3 Tel Aviv University, Israel; 4 Hadassah-Hebrew University Medical Center, Israel; 5 Hebrew University, Israel Introduction: While the positive effects that deep brain stimulation (DBS) of the subthalamic nucleus (STN) exerts on motor functions in patients with Parkinson’s disease (PD) are well known, not all patients respond similarly to the treatment. One plausible explanation is the numerous combinations between the chosen DBS electrode contacts and programming settings that include voltage, pulse width and frequency. Consequently, on average, finding the setting for optimal symptom control requires on average 6 sessions over 6 months. The current study aims to develop an innovative method for objective differentiation between the locations of the four DBS contacts in the various parts of the STN as a first step towards automated treatment optimization, using a novel EEG-based tool called BNA (Brain Network Activation). Methods: 128-channel EEG was recorded from seven DBS treated PD patients. Low-frequency stimulation at 2-5 Hz was applied to each of the four DBS contacts for several minutes. A total of 2000e2400 EEG epochs, aligned to stimulation onset, were averaged to produce a DBS Evoked Response per DBS contact (numbered 0 for most ventral to 3 for most dorsal). The DBS BNA was calculated for a predefined time-window of 50e100 ms after stimulation onset. Results: The DBS BNA significantly differentiated between the most dorsal DBS electrode contact (in most cases located above the STN, in the zona incerta) and the two ventral contacts in the medial frontal central scalp area (F¼5.1, p<0.01, 1-way ANOVA; p<0.02 and 0.03 for 3 vs. 0 and 3 vs. 1, respectively). Conclusions: We showed that by using scalp EEG we can distinguish between 4 DBS contacts located in the STN. This novel objective non-invasive measure will potentially transform the time-consuming DBS calibration into a quick and efficient optimization process. This study was conducted in collaboration with Alpha Omega LTD. Keywords: DBS, EEG, Parkinson Disease
[0689] EFFECT OF TRANSCRANIAL DIRECT CURRENT STIMULATION OVER PRIMARY MOTOR CORTEX ON STATIC BALANCE IN HEALTHY INDIVIDUALS H. Pasin Neto 1, 3, L.A.C. Grecco 2, N.A.C. Duarte 3, L.V.F. Oliveira 3, C.S. Oliveira*3. 1 Universidade de Sorocaba, Brazil; 2 Pediatric Neurostimulation Center, Brazil; 3 Universidade Nove de Julho, Brazil
Patient was started on the Nemechek Protocol which consists of patientadministered tVNS 2 hours per day (5 Hz, 250 uS, 1 mA) via the tragus, Rifaximin (550 mg BID x 10d) and daily supplementation with 3,000 mg of DHA (fish oil) plus 30 ml of EVOO. Results: After 4 months of treatment, RFa (parasympathetic) and LFa responses remained normal on deep breathing (DB), valsalva (Val) and RFa on orthostatic challenge (OC). The weak LFa response on OC normalized after treatment. The treatment was well tolerated, and the patient’s symptoms resolved.
Spectral Analysis (bpm2) After 4 Months on Therapy
Baseline Treated
Rest
Rest
DB
Val
Val
OC
OC
LFa
RFa
RFa
LFa
RFa
LFa
RFa
7.13 3.41
5.20 7.31
103.6 90.8
142.9 78.9
17.5 17.14
3.5 6.08
1.77 1.02
Conclusion: Incorporation of tVNS in the Nemechek Protocol produces an treatment regimen capable of reversing chronic autonomic dysfunction and symptoms associated with postconcussion syndrome. This simple and inexpensive regimen make is an accessible treatment regimen for reversal of autonomic dysfunction associated with postconcussion syndrome. Keywords: VNS, autonomic, concussion, inflammation [0681] DIFFUSION TENSOR IMAGING EVALUATION OF NEURAL NETWORK DEVELOPMENT IN PATIENTS UNDERGOING THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION FOLLOWING STROKE N. Yamada*1, R. Ueda 3, W. Kakuda 1, R. Momosaki 1, T. Kondo 2, T. Hara 1, A. Senoo 3, M. Abo 1. 1 The Jikei University School of Medicine, Japan; 2 Shimizu Hospital, Japan; 3 Tokyo Metropolitan University, Japan Introduction: Motor function recovery in patients with stroke is considered to be largely due to plastic changes in the cerebral cortex. In the present study, we investigated plastic changes in cerebral white matter structures following a 15-day rehabilitation period using generalized fractional anisotropy (GFA) values. Methods: Thirty-six patients with upper limb hemiparesis due to stroke received a therapeutic protocol comprising 12 sessions of repetitive transcranial magnetic stimulation (rTMS) consisting of 2,400 pulses applied to the non-lesional hemisphere and a 240-min intensive occupational therapy (OT; 40-min one-to-one training for three times and 120-min self-training) daily for 15 days. Motor function was evaluated using the Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT). Patients underwent diffusion-tensor magnetic resonance imaging (MRI) on admission and discharge, from which
Ă
509
bilateral GFA values in Brodmann area (BA) 4 and BA6 were calculated (GFA value range of 0 to 1). Results: All patients completed the 15-day protocol without experiencing any adverse effects. Motor function improved following treatment (p < 0.001). Treatment increased GFA values for lesioned BA4 (p < 0.05) as well as those for non-lesioned BA4 (p < 0.001). The change in GFA value for BA4 of the lesioned hemisphere was significantly inversely correlated with changes in WMFT scores (R2 ¼ 0.363, p < 0.05). Discussion: The application of low-frequency rTMS combined with intensive OT resulted in increased GFA values in BA4, as well as improvements in upper limb hemiparesis, suggesting that the combined rTMS-OT intervention may induce beneficial plastic changes in cerebral white matter structures, though the lack of a control group in the present study limits this interpretation. Serial assessments of GFA values seem to provide reliable evidence of structural changes in cerebral white matter in patients undergoing rehabilitative intervention following hemiparetic stroke, although further studies are required to confirm this finding. Keywords: diffusion tensor imaging, transcranial magnetic stimulation, neural network, generalized fractional anisotropy [0682] EFFECTIVENESS OF RTMS IN DEPRESSION: A BRIEF REPORT M. Pirmoradi*, F. Asadi. Iran University of Medical Science, Iran Introduction: Transcranial magnetic stimulation (TMS) is an important method for noninvasive stimulation of brain in treatment of depression. During the past 10 years, therapeutic effects of repeated Transcranial Magnetic Stimulation (rTMS) have been widely studied in psychiatry and its efficacy has been demonstrated in the treatment of major depressive disorders.In my study,we explored the effectiveness of antidepressant course of rTMS in major depression. I treated four patients with rTMS and constant medication . Methods: Based on SCID and DSM IVTR four depressed patients who reffered to Sobhe Sadeg center treated with rTMS for 15 sessions( three days a week) when he got constant medication.Upon the intervention they were tested with BDI to determine the effect of treatment for five times. Results: Three weeks trial of repetitive transcranial magnetic stimulation in this research showed a good effects in reduced of BDI test . Conclusion: Finding suggest that transcranial magnetic stimulation is a good and searchable device for combination therapy in treatment of major depressive disorders. Keywords: Major depression disorder, Transcranial magnetic stimulation, Antidepressant. [0683] USING TRANSCRANIAL ELECTRICAL STIMULATION (TES) MOTOR THRESHOLD TO POTENTIALLY DETERMINE INDIVIDUAL TRANSCRANIAL DIRECT CURRENT STIMULATION (TDCS) DOSING
510
Abstracts / Brain Stimulation 10 (2017) 346e540
B.W. Badran*, E. Kofmehl, J.J. Borckardt, M. Bikson, C. Mullins, P. Summers, M.S. George. 1 Medical University of South Carolina, USA; 2 The City College of New York, USA; 3 Ralph H. Johnson VA Medical Center, USA Introduction: Researchers have not yet determined a method for individually dosing tDCS. This lack of dosing and titration has likely contributed to the reproducibility and clinical trial difficulties. Using single-pulse transcranial electrical stimulation (TES) thresholds as a surrogate for tDCS, we aimed to determine whether objective recordings (TMS neurophysiology, individual MRI measures and scalp resistance) might determine individual tDCS dosing. Methods: 30 healthy adults (15 female) participated in this two-visit trial. In the first experimental visit, TMS was used to determine left motor hotspot and conventional neurophysiological recordings were acquired (rMT, PPI, CSP, RC). Scalp resistance was then recorded and 5 single-pulses of TES (constant current, PW: 200ms) were administered using tab electrodes (anode e left motor hotspot, cathode e left deltoid). Active right thumb MEPs elicited by TES pulses were recorded using Spike2 and the TES motor threshold was determined using a PEST algorithm similar to TMS rMT. The second visit was an MRI scan in which a structural image was acquired (fiducial over the motor hotspot) from which scalp to cortex distance was recorded. Results: The TES procedure was well tolerated without dropouts (TES threshold marginally more painful than TMS thresholds). A regression analysis was conducted using all objective recordings and a formula for predicting threshold was generated using factors statistically determined to be relevant (gender, TMS rMT, scalp resistance). The following model only accounts for 15% of the variance observed: TES threshold ¼ 43.69 + (6.551 X Sex) + (.507 X rMT) + (-.003 X mU) Discussion: TES is a safe and relatively painless surrogate of tDCS. Of all recordings, only relevant gender, TMS rMT, and scalp resistance were able to predict only 15% of TES variance. TES thresholds are a feasible and effective surrogate method for tDCS and should be explored in refining tDCS methodology. Keywords: tDCS, Dose, transcranial electrical stimulation (TES)
[0687] NEW EEG MEASURES AT THE BEGINNING OF MDD RTMS TREATMENT PREDICT ITS EFFICIENCY: PRELIMINARY RESULTS R. Shani-Hershkovich*1, D. Haor 1,2, A. Amit 1, U. Alyagon 2, D. Shmuel 4, A. Zangen 2, Y. Levkovitz 3, 4, A.B. Geva 1, 2, Z. Peremen 1, 3. 1 ElMindA LTD., Israel; 2 Ben Gurion University, Israel; 3 Tel Aviv University, Israel; 4 Beer-Yaacov Mental Health Center, Israel Background: In recent years, many electroencephalography (EEG)-based predictors for major depressive disorder (MDD) treatment outcomes have been reported. These studies attempted to classify subjects as future responders/non-responders by measures taken before treatment. In this study, we examined a novel EEG measure, ongoing Brain Network Activation (oBNA), acquired during repetitive transcranial magnetic stimulation (rTMS) treatment, as a potential predictor of treatment efficiency. Methods: Eighteen medication-resistant MDD patients received full multiple-site rTMS treatment. The first session included a simultaneous EEG recording. Hamilton Depression Rating Scale (HDRS-17) was measured before the first and last treatment sessions, and the percent of change was calculated. Each treatment contained 1Hz stimulation (right dorsolateral prefrontal cortex; DLPFC) throughout the treatment session, and 20Hz (left DLPFC) 1-second trains, every 15 seconds. 13-second epochs, after each 20Hz stimulation train, were processed through an automatic algorithm that removes EEG artifact. Frequency domain oBNA was calculated for each epoch. A novel inter-trial-difference (ITD) measure that reflects the oBNA difference between the start and the end of a treatment session was evaluated as a predictor. In addition, we evaluated the oBNA scores at different frequency bands as predictors.
Results: (1) oBNA ITD in the low-gamma frequency, across frontal electrodes, was found to be significantly correlated to the %change of HDRS-17 (r¼0.78, p<0.001). (2) Low-gamma and (3) high-beta frequency oBNA also significantly correlated with %change HDRS. The ITD and the low gamma oBNA features were found to be the most predictive measures (PPV/ NPV¼0.79/1 and PPV/NPV¼0.9/0.82, respectively). Summary: Our preliminary results show that all three tested ongoing EEG measures successfully predict rTMS treatment outcomes. We suggest that a combination of several parameters on a larger sample will yield an even more reliable prediction, to serve an accessible objective clinical tool during treatment selection. This study was conducted in collaboration with Brainsway LTD. Keywords: EEG, rTMS, MDD, BNA [0688] OPTIMIZATION OF DEEP BRAIN STIMULATION IN STN AMONG PATIENTS WITH PARKINSON'S DISEASE USING A NOVEL EEG-BASED TOOL D. Sand*1, Z. Peremen 1, 3, D. Haor 1, 2, D. Arkadir 4, H. Bergman 5, A. Geva 1,2. 1 ElMindA Ltd, Israel; 2 Ben Gurion University, Israel; 3 Tel Aviv University, Israel; 4 Hadassah-Hebrew University Medical Center, Israel; 5 Hebrew University, Israel Introduction: While the positive effects that deep brain stimulation (DBS) of the subthalamic nucleus (STN) exerts on motor functions in patients with Parkinson’s disease (PD) are well known, not all patients respond similarly to the treatment. One plausible explanation is the numerous combinations between the chosen DBS electrode contacts and programming settings that include voltage, pulse width and frequency. Consequently, on average, finding the setting for optimal symptom control requires on average 6 sessions over 6 months. The current study aims to develop an innovative method for objective differentiation between the locations of the four DBS contacts in the various parts of the STN as a first step towards automated treatment optimization, using a novel EEG-based tool called BNA (Brain Network Activation). Methods: 128-channel EEG was recorded from seven DBS treated PD patients. Low-frequency stimulation at 2-5 Hz was applied to each of the four DBS contacts for several minutes. A total of 2000e2400 EEG epochs, aligned to stimulation onset, were averaged to produce a DBS Evoked Response per DBS contact (numbered 0 for most ventral to 3 for most dorsal). The DBS BNA was calculated for a predefined time-window of 50e100 ms after stimulation onset. Results: The DBS BNA significantly differentiated between the most dorsal DBS electrode contact (in most cases located above the STN, in the zona incerta) and the two ventral contacts in the medial frontal central scalp area (F¼5.1, p<0.01, 1-way ANOVA; p<0.02 and 0.03 for 3 vs. 0 and 3 vs. 1, respectively). Conclusions: We showed that by using scalp EEG we can distinguish between 4 DBS contacts located in the STN. This novel objective non-invasive measure will potentially transform the time-consuming DBS calibration into a quick and efficient optimization process. This study was conducted in collaboration with Alpha Omega LTD. Keywords: DBS, EEG, Parkinson Disease
[0689] EFFECT OF TRANSCRANIAL DIRECT CURRENT STIMULATION OVER PRIMARY MOTOR CORTEX ON STATIC BALANCE IN HEALTHY INDIVIDUALS H. Pasin Neto 1, 3, L.A.C. Grecco 2, N.A.C. Duarte 3, L.V.F. Oliveira 3, C.S. Oliveira*3. 1 Universidade de Sorocaba, Brazil; 2 Pediatric Neurostimulation Center, Brazil; 3 Universidade Nove de Julho, Brazil