Effects of transcranial direct current stimulation (tDCS) and concurrent cognitive training on episodic memory in patients with traumatic brain injury: a double-blind, randomised, placebo-controlled study.

INTRODUCTION: Deficits in episodic memory following traumatic brain injury (TBI) are common and affect independence in activities of daily living. Transcranial direct current stimulation (tDCS) and concurrent cognitive training may contribute to improve episodic memory in patients with TBI. Although previous studies have shown the potential of tDCS to improve cognition, the benefits of the tDCS applied simultaneously to cognitive training in participants with neurological disorders are inconsistent. This study aims to (1) investigate whether active tDCS combined with computer-assisted cognitive training enhances episodic memory compared with sham tDCS; (2) compare the differences between active tDCS applied over the left dorsolateral prefrontal cortex (lDLPFC) and bilateral temporal cortex (BTC) on episodic memory and; (3) investigate inter and intragroup changes on cortical activity measured by quantitative electroencephalogram (qEEG). METHODS AND ANALYSIS: A randomised, parallel-group, double-blind placebo-controlled study is conducted. Thirty-six participants with chronic, moderate and severe closed TBI are being recruited and randomised into three groups (1:1:1) based on the placement of tDCS sponges and electrode activation (active or sham). TDCS is applied for 10 consecutive days for 20 min, combined with a computer-based cognitive training. Cognitive scores and qEEG are collected at baseline, on the last day of the stimulation session, and 3 months after the last tDCS session. We hypothesise that (1) the active tDCS group will improve episodic memory scores compared with the sham group; (2) differences on episodic memory scores will be shown between active BTC and lDLPFC and; (3) there will be significant delta reduction and an increase in alpha waves close to the location of the active electrodes compared with the sham group. ETHICS AND DISSEMINATION: This study was approved by Hospital das Clínicas, University of São Paulo Ethical Institutional Review Border (CAAE: 87954518.0.0000.0068). TRIAL REGISTRATION NUMBER: NCT04540783.

Controvérsias sobre a co-administração lamotrigina e valproato de sódio / Controversies about co-administration lamotrigine and valproate

A monoterapia em dose adequada, eficaz no controle de crises e associada a mínimos ou imperceptíveis efeitos colaterais permanece como meta no tratamento clínico das epilepsias. É provável que funcione metade dos casos ou em torno deste número. As associações de fármacos antiepilépticos serão inevitáveis em um outro grupo de pacientes, com crises de controle mais difícil. O sucesso nestes casos estará diretamente ligado a combinações pertinentes de drogas e ao conhecimento e manejo das sutilezas envolvidas em cada uma delas. Em várias existe alguma lógica, academicamente chamada politerapia racional. Em outras, intuição e até um pouco de sorte podem traduzir a diferença entre um controle mais ou menos adequado de crises. Lamotrigina e ácido valpróico são frequentemente associados e com bom resultado. Porém as verdadeiras razões para este bom relacionamento farmacológico não são perfeitamente conhecidas. Trata-se do detalhamento de uma prática diária em ambulatório de epilepsias e portanto conhecimento indispensável para os que se propõe a utilizá-la