Traitement de la douleur chronique: rôle de la stimulation transcrânienne du cortex moteur [Treatment of chronic pain: transcranial stimulation of the motor cortex?].

Chronic pain refractory to medical therapy poses a therapeutic challenge. The repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS) modulate brain activity offering a new approach. Current evidence suggests a potential therapeutic efficacy of motor cortex stimulation for the treatment of pain, but does not (yet) support their recommendation for clinical practice. These methods allow to deepen our knowledge in the pathophysiology of chronic pain while providing new therapeutic approaches.

Imaging the time-integrated cerebral metabolic activity with subcellular resolution through nanometer-scale detection of biosynthetic products deriving from (13)C-glucose.

Glucose is the primary source of energy for the brain but also an important source of building blocks for proteins, lipids, and nucleic acids. Little is known about the use of glucose for biosynthesis in tissues at the cellular level. We demonstrate that local cerebral metabolic activity can be mapped in mouse brain tissue by quantitatively imaging the biosynthetic products deriving from [U-(13)C]glucose metabolism using a combination of in situ electron microscopy and secondary ion mass-spectroscopy (NanoSIMS). Images of the (13)C-label incorporated into cerebral ultrastructure with ca. 100nm resolution allowed us to determine the timescale on which the metabolic products of glucose are incorporated into different cells, their sub-compartments and organelles. These were mapped in astrocytes and neurons in the different layers of the motor cortex. We see evidence for high metabolic activity in neurons via the nucleus (13)C enrichment. We observe that in all the major cell compartments, such as e.g. nucleus and Golgi apparatus, neurons incorporate substantially higher concentrations of (13)C-label than astrocytes.

Neural synchrony indexes impaired motor slowing after errors and novelty following white matter damage.

In humans, action errors and perceptual novelty elicit activity in a shared frontostriatal brain network, allowing them to adapt their ongoing behavior to such unexpected action outcomes. Healthy and pathologic aging reduces the integrity of white matter pathways that connect individual hubs of such networks and can impair the associated cognitive functions. Here, we investigated whether structural disconnection within this network because of small-vessel disease impairs the neural processes that subserve motor slowing after errors and novelty (post-error slowing, PES; post-novel slowing, PNS). Participants with intact frontostriatal circuitry showed increased right-lateralized beta-band (12-24 Hz) synchrony between frontocentral and frontolateral electrode sites in the electroencephalogram after errors and novelty, indexing increased neural communication. Importantly, this synchrony correlated with PES and PNS across participants. Furthermore, such synchrony was reduced in participants with frontostriatal white matter damage, in line with reduced PES and PNS. The results demonstrate that behavioral change after errors and novelty result from coordinated neural activity across a frontostriatal brain network and that such cognitive control is impaired by reduced white matter integrity.

Insulation System in an Integrated Motor Compressor

A high-speed and high-voltage solid-rotor induction machine provides beneficial features for natural gas compressor technology. The mechanical robustness of the machine enables its use in an integrated motor-compressor. The technology uses a centrifugal compressor, which is mounted on the same shaft with the high-speed electrical machine driving it. No gearbox is needed as the speed is determined by the frequency converter. The cooling is provided by the process gas, which flows through the motor and is capable of transferring the heat away from the motor. The technology has been used in the compressors in the natural gas supply chain in the central Europe. New areas of application include natural gas compressors working at the wellheads of the subsea gas reservoir. A key challenge for the design of such a motor is the resistance of the stator insulation to the raw natural gas from the well. The gas contains water and heavy hydrocarbon compounds and it is far harsher than the sales gas in the natural gas supply network. The objective of this doctoral thesis is to discuss the resistance of the insulation to the raw natural gas and the phenomena degrading the insulation. The presence of partial discharges is analyzed in this doctoral dissertation. The breakdown voltage of the gas is measured as a function of pressure and gap distance. The partial discharge activity is measured on small samples representing the windings of the machine. The electrical field behavior is also modeled by finite element methods. Based on the measurements it has been concluded that the discharges are expected to disappear at gas pressures above 4 – 5 bar. The disappearance of discharges is caused by the breakdown strength of the gas, which increases as the pressure increases. Based on the finite element analysis, the physical length of a discharge seen in the PD measurements at atmospheric pressure was approximated to be 40 – 120 m. The chemical aging of the insulation when exposed to raw natural gas is discussed based on a vast set of experimental tests with the gas mixture representing the real gas mixture at the wellhead. The mixture was created by mixing dry hydrocarbon gas, heavy hydrocarbon compounds, monoethylene glycol, and water. The mixture was chosen to be more aggressive by increasing the amount of liquid substances. Furthermore, the temperature and pressure were increased, which resulted in accelerated test conditions. The time required to detect severe degradation was thus decreased. The test program included a comparison of materials, an analysis of the e ects of di erent compounds in the gas mixture, namely water and heavy hydrocarbons, on the aging, an analysis of the e ects of temperature and exposure duration, and also an analysis on the e ect of sudden pressure changes on the degradation of the insulating materials. It was found in the tests that an insulation consisting of mica, glass, and epoxy resin can tolerate the raw natural gas, but it experiences some degradation. The key material in the composite insulation is the resin, which largely defines the performance of the insulation system. The degradation of the insulation is mostly determined by the amount of gas mixture di used into it. The di usion was seen to follow Fick’s second law, but the coe cients were not accurately defined. The di usion was not sensitive to temperature, but it was dependent upon the thermodynamic state of the gas mixture, in other words, the amounts of liquid components in the gas. The weight increase observed was mostly related to heavy hydrocarbon compounds, which act as plasticizers in the epoxy resin. The di usion of these compounds is determined by the crosslink density of the resin. Water causes slight changes in the chemical structure, but these changes do not significantly contribute to the aging phenomena. Sudden changes in pressure can lead to severe damages in the insulation, because the motion of the di used gas is able to create internal cracks in the insulation. Therefore, the di usion only reduces the mechanical strength of the insulation, but the ultimate breakdown can potentially be caused by a sudden drop in the pressure of the process gas.

Serotonergic neurons in the caudal raphe nuclei discharge in association with activity of masticatory muscles

There is a dense serotonergic projection from nucleus raphe pallidus and nucleus raphe obscurus to the trigeminal motor nucleus and serotonin exerts a strong facilitatory action on the trigeminal motoneurons. Some serotonergic neurons in these caudal raphe nuclei increase their discharge during feeding. The objective of the present study was to investigate the possibility that the activity of these serotonergic neurons is related to activity of masticatory muscles. Cats were implanted with microelectrodes and gross electrodes. Caudal raphe single neuron activity, electrocorticographic activity, and splenius, digastric and masseter electromyographic activities were recorded during active behaviors (feeding and grooming), during quiet waking and during sleep. Seven presumed serotonergic neurons were identified. These neurons showed a long duration action potential (>2.0 ms), and discharged slowly (2-7 Hz) and very regularly (interspike interval coefficient of variation <0.3) during quiet waking. The activity of these neurons decreased remarkably during fast wave sleep (78-100%). Six of these neurons showed tonic changes in their activity positively related to digastric and/or masseter muscle activity but not to splenius muscle activity during waking. These data are consistent with the hypothesis that serotonergic neurons in the caudal raphe nuclei play an important role in the control of jaw movements

Evaluation of electromyographic activity and heart rate responses to isometric exercise. The role played by muscular mass and type

The purpose of the present study was to examine the relationship between the electromyographic (EMG) activity and heart rate (HR) responses induced by isometric exercise performed by knee extension (KE) and flexion (KF) in men. Fifteen healthy male subjects, 21 ± 1.3 years (mean ± SD), were submitted to KE and KF isometric exercise tests at 100% of maximal voluntary contraction (MVC). The exercises were performed with one leg (right or left) and with two legs simultaneously, for 10 s in the sitting position with the hip and knee flexed at 90o. EMG activity (root mean square values) and HR (beats/min) were recorded simultaneously both at rest and throughout the sustained contraction. The HR responses to isometric exercise in KE and KF were similar when performed with one and two legs. However, the HR increase was always significantly higher in KE than KF (P<0.05), whereas the EMG activity was higher in KE than in KF (P<0.05), regardless of the muscle mass (one or two legs) involved in the effort. The correlation coefficients between HR response and the EMG activity during KE (r = 0.33, P>0.05) and KF (r = 0.15, P>0.05) contractions were not significant. These results suggest that the predominant mechanism responsible for the larger increase in HR response to KE as compared to KF in our study could be dependent on qualitative and quantitative differences in the fiber type composition found in each muscle group. This mechanism seems to demand a higher activation of motor units with a corresponding increase in central command to the cardiovascular centers that modulate HR control.

A gasometric method to determine erythrocyte catalase activity

We describe a new gasometric method to determine erythrocyte catalase activity by the measurement of the volume of oxygen produced as a result of hydrogen peroxide decomposition in a system where enzyme and substrate are separated in a special reaction test tube connected to a manometer and the reagents are mixed with a motor-driven stirrer. The position of the reagents in the test tube permits the continuous measurement of oxygen evolution from the time of mixing, without the need to stop the reaction by the addition of acid after each incubation time. The enzyme activity is reported as KHb, i.e., mg hydrogen peroxide decomposed per second per gram of hemoglobin (s-1 g Hb-1). The value obtained for catalase activity in 28 samples of hemolyzed human blood was 94.4 ± 6.17 mg H2O2 s-1 g Hb-1. The results obtained were precise and consistent, indicating that this rapid, simple and inexpensive method could be useful for research and routine work.

Behavioral correlates of the activity of serotonergic and non-serotonergic neurons in caudal raphe nuclei

We investigated the behavioral correlates of the activity of serotonergic and non-serotonergic neurons in the nucleus raphe pallidus (NRP) and nucleus raphe obscurus (NRO) of unanesthetized and unrestrained cats. The animals were implanted with electrodes for recording single unit activity, parietal oscillographic activity, and splenius, digastric and masseter electromyographic activities. They were tested along the waking-sleep cycle, during sensory stimulation and during drinking behavior. The discharge of the serotonergic neurons decreased progressively from quiet waking to slow wave sleep and to fast wave sleep. Ten different patterns of relative discharge across the three states were observed for the non-serotonergic neurons. Several non-serotonergic neurons showed cyclic discharge fluctuations related to respiration during one, two or all three states. While serotonergic neurons were usually unresponsive to the sensory stimuli used, many non-serotonergic neurons responded to these stimuli. Several non-serotonergic neurons showed a phasic relationship with splenius muscle activity during auditory stimulation. One serotonergic neuron showed a tonic relationship with digastric muscle activity during drinking behavior. A few non-serotonergic neurons exhibited a tonic relationship with digastric and/or masseter muscle activity during this behavior. Many non-serotonergic neurons exhibited a phasic relationship with these muscle activities, also during this behavior. These results suggest that the serotonergic neurons in the NRP and NRO constitute a relatively homogeneous population from a functional point of view, while the non-serotonergic neurons form groups with considerable functional specificity. The data support the idea that the NRP and NRO are implicated in the control of somatic motor output.

Investigating the association between motor proficiency and body satisfaction in grade 5 children

The inverse relationships between motor proficiency and overweight, and between overweight and body satisfaction have been well documented. However, the association between motor proficiency and body satisfaction has been largely neglected in the literature. Knowledge of the influence that low motor proficiency may have on body satisfaction is essential if the full burden that those children with poor motor abilities face is to be fully recognized, as low body satisfaction has been linked to an increased risk for low self-esteem, depression, and disordered eating. The cohort investigated in this report included 1907 (971 males, 936 female) Grade 5 students from the Physical Health Activity Study Team (PHAST) project in the Niagara Region of Southern Ontario. Children were grouped as overweight or healthy weight (using BMI cut offs for age and gender), and as low motor proficiency or normal motor proficiency (cut-off set at lowest 10% Bruininks Oseretsky Test of Motor Proficiency-short form (BOTMPsf). It was apparent from analyses of variance (ANOVAs) by gender that boys demonstrated significantly higher motor proficiency scores. As a result separate multiple logistic regressions by gender were used to determine the relationship between body satisfaction, BMI, and motor proficiency. There was a significant relationship between BMI and body satisfaction for both genders (p<0.01) and for males a significant relationship between motor proficiency and body satisfaction (p<0.03). Overweight females were less likely to be satisfied with their bodies with an odds ratio (OR) of 0.33 (CI: 0.23-0.47). The same trend was found in overweight males (OR: 0.42, CI: 0.29-0.59). Males with low motor proficiency were significantly less satisfied with their bodies (OR: 0.53, CI: 0.29-0.97). Males with poor motor proficiency were at greater risk for low body satisfaction regardless of their overweight status. Overweight is known to be prevalent among children with low motor proficiency and, these results indicate that low body satisfaction is also a significant concern. These findings confirm that attention needs to be paid to perceptions of body satisfaction among children with low motor proficiency. This is particularly true for boys, as their bodies may fail them in two common societal expectations, shape and skill and for whom their risk of low body satisfaction is heightened by their poor motor proficiency.

Physical activity of children with developmental coordination disorder in the presence of attention deficit hyperactivity disorder : does gender matter?

Baerg, S., Cairney, J., Hay, J., Rempel, L. and Faught, B.E. (2009). Physical Activity of Children with Developmental Coordination Disorder in the Presence of Attention Deficit Hyperactivity Disorder: Does Gender Matter? Brock University, St. Catharines, Ontario, CANADA. Children with Developmental Coordination Disorder (DCD) have difficulties in motor coordination. Attention-deficit hyperactive disorder (ADHD) is considered the condition most co-morbid with DCD at approximately 50%. Children with DCD are generally less physically active (PA) than their peers, while children with ADHD are often considered more physically active. It is not known if the physical activity patterns of children with DCD-ADHD resemble those of children with primarily DCD or that of their healthy peers. The primary objective of this research was to contrast physical activity patterns between children with DCD, DCD-ADHD, and healthy controls. Since boys are generally reported as more physically active than girls, a secondary objective was to determine if gender moderated the association between groups and physical activity. A sample of males (n=66) and females (n=44) were recruited from the Physical Health Activity Study Team (PHAST) longitudinal study. The Movement Assessment Battery for Children (2nd Ed.) was used to identify probable cases of DCD, and Connor's Revised Parent Rating Scale- Short Version to identify ADHD. Subjects (mean age=12.8±.4 yrs) were allocated to three groups; DCD (n=32), DCD-ADHD (n=30) and control (n=48). Physical activity was monitored for seven days with the Actical® accelerometer (activity count, step count and energy expenditure). Children completed the Participation Questionnaire (PQ) during the in-school session of data collection for the PHAST study. Height, weight and body mass index (BMI) were also determined. Analysis of variance showed significant group differences for activity count (F(2,56)=5.36, p=.007) and PQ (F(2,44 )=6. 71, p=.003) in males, while a significant group difference for step count (F(2,37)=3.55, p=.04) was found in females. Post hoc comparison tests (Tukey) identified significantly lower PQ and activity count between males with OCD and controls (p=.004) and males with DCD-ADHD and controls (p=.003). Conversely, females with DCD-ADHD had significantly more step counts than their controls (p=.01). Analysis of covariance demonstrated a gender by DCD groups negative interaction for males (activity count) (F(2,92):;:3.11, p=.049) and a positive interaction for females (step count) (F(1,92)=4.92, p=.009). Hyperactivity in females with DCD-ADHD appears to contribute to more physical activity, whereas DCD may contribute to decreased activity in males with DCD and DCDADHD. Further research is needed to examine gender differences in physical activity within the context of DCD and ADHD.

Decreased motor unit firing rate in the potentiated tibialis anterior in humans

With repeated activity, force production, rate of force production, and relaxation time are impaired. These are characteristics ofa fatigued muscle (Vandenboom, 2004). However, brief bouts of near maximal to maximal activity results in the increased ability of the muscle to generate force, termed post activation potentiation (P AP)(V andervoort et aI., 1983). The purpose of the present study was to characterize motor unit firing rate (MUFR) in the unfatigued, potentiated tibialis anterior (TA). Using a quadrifilar needle electrode, MUFR was measured during a 5s 50% MVC in which the TA was either potentiated or unpotentiated; monopolar electrodes measured surface parameters. A lOs MVC was used to potentiate the muscle. Firing rate decreased significantly from 20.15±2.9Opps to 18.27±2.99pps, while mean power frequency decreased significantly from 60. 13±7.75 Hz to 53.62±8.56 Hz. No change in root mean square (RMS) was observed. Therefore, in the present study, MUFR decreases in response to a potentiated TA.

The role of physical activity and perceived adequacy on cardiorespiratory fitness in children with developmental coordination disorder

Evidence suggests that children with developmental coordination disorder (DCD) have lower levels of cardiorespiratory fitness (CRF) compared to children without the condition. However, these studies were restricted to field-based methods in order to predict V02 peak in the determination of CRF. Such field tests have been criticised for their ability to provide a valid prediction of V02 peak and vulnerability to psychological aspects in children with DCD, such as low perceived adequacy toward physical activity. Moreover, the contribution of physical activity to the variance in V02 peak between the two groups is unknown. The purpose of our study was to determine the mediating role of physical activity and perceived adequacy towards physical activity on V02 peak in children with significant motor impairments. This prospective case-control design involved 122 (age 12-13 years) children with significant motor impairments (n=61) and healthy matched controls (n=61) based on age, gender and school location. Participants had been previously assessed for motor proficiency and classified as a probable DCD (p-DCD) or healthy control using the movement ABC test. V02 peak was measured by a progressive exercise test on a cycle ergometer. Perceived adequacy was measured using a 7 -item subscale from Children's Selfperception of Adequacy and Predilection for Physical Activity scale. Physical activity was monitored for seven days with the Actical® accelerometer. Children with p-DCD had significantly lower V02 peak (48.76±7.2 ml/ffm/min; p:50.05) compared to controls (53.12±8.2 ml/ffm/min), even after correcting for fat free mass. Regression analysis demonstrated that perceived adequacy and physical activity were significant mediators in the relationship between p-DCD and V02 peak. In conclusion, using a stringent laboratory assessment, the results of the current study verify the findings of earlier studies, adding low CRF to the list of health consequences associated with DCD. It seems that when testing for CRF in this population, there is a need to consider the psychological barriers associated with their condition. Moreover, strategies to increase physical activity in children with DCD may result in improvement in their CRF.

Physical Activity and Fitness in Children with Developmental Disorder

Introduction: Developmental coordination disorder (DCD) is a prevalent condition characterized by poor motor proficiency that interferes with a child‟s activities of daily living. Children with DCD often experience compromised health-related fitness components such as cardiorespiratory fitness (CRF). Purpose: To better understand the physical activity and fitness characteristics of children with probable DCD (pDCD), with a particular focus on CRF. Specifically: (1) to present a synopsis of current literature; (2) to determine the longitudinal trajectories of CRF; (3) to compare the submaximal CRF of children with and without pDCD. Methods: A comprehensive, systematic literature review was conducted of the recent available data on fitness and physical activity and pDCD (Chapter 2). This review provided the background for the other two studies included in this thesis. In Chapter 3, a prospective cohort design was used to assess how CRF in children with pDCD changes over time (56 months) relative to a group of typically developing controls. Using a nested-case control design, 63 subjects with pDCD and 63 matched controls from the larger sample were recruited to participate in the lab-based component of the study (Chapter 4). In this investigation CRF was examined using the oxygen cost of work (VO2) during an incremental test on a cycle ergometer. Results: The literature review showed that fitness parameters, including CRF and physical activity levels, were consistently reduced in children with pDCD. Chapter 3 demonstrated that the difference in CRF between children with pDCD and typically developing children is substantial, and that it tends to increase over time. Results from VO2 assessments showed that children with pDCD utilized more oxygen to sustain the same submaximal workloads compared to typically developing children. Conclusions: Findings from this thesis have made several important contributions to our understanding of children with pDCD. Since differences in CRF between children with and without pDCD tend to worsen over time, this adds to the argument that interventions intended to improve CRF may be appropriate for children with motor difficulties. This thesis also presented the first evidence suggesting that DCD involves higher energy expenditure, and could help explain why children with pDCD perform poorly on tasks requiring CRF.

Src family kinases are required for limb trajectory selection by spinal motor axons

Signal relay by guidance receptors at the axonal growth cone is a process essential for the assembly of a functional nervous system. We investigated the in vivo function of Src family kinases (SFKs) as growth cone guidance signaling intermediates in the context of spinal lateral motor column (LMC) motor axon projection toward the ventral or dorsal limb mesenchyme. Using in situ mRNA detection we determined that Src and Fyn are expressed in LMC motor neurons of chick and mouse embryos at the time of limb trajectory selection. Inhibition of SFK activity by C-terminal Src kinase (Csk) overexpression in chickLMCaxons using in ovo electroporation resulted inLMC axons selecting the inappropriate dorsoventral trajectory within the limb mesenchyme, with medial LMC axon projecting into the dorsal and ventral limb nerve with apparently random incidence. We also detected LMC axon trajectory choice errors in Src mutant mice demonstrating a nonredundant role for Src in motor axon guidance in agreement with gain and loss of Src function in chickLMCneurons which led to the redirection ofLMCaxons. Finally, Csk-mediated SFK inhibition attenuated the retargeting ofLMCaxons caused by EphA or EphB over-expression, implying the participation of SFKs in Eph-mediated LMC motor axon guidance. In summary, our findings demonstrate that SFKs are essential for motor axon guidance and suggest that they play an important role in relaying ephrin:Eph signals that mediate the selection of motor axon trajectory in the limb.

Rhythmic Masticatory Muscle Activity during Sleep: Etiology and Clinical Perspectives

L’activité rythmique des muscles masticateurs (ARMM) pendant le sommeil se retrouve chez environ 60% de la population générale adulte. L'étiologie de ce mouvement n'est pas encore complètement élucidée. Il est cependant démontré que l’augmentation de la fréquence des ARMM peut avoir des conséquences négatives sur le système masticatoire. Dans ce cas, l'ARMM est considérée en tant que manifestation d'un trouble moteur du sommeil connue sous le nom de bruxisme. Selon la Classification Internationale des Troubles du Sommeil, le bruxisme est décrit comme le serrement et grincement des dents pendant le sommeil. La survenue des épisodes d’ARMM est associée à une augmentation du tonus du système nerveux sympathique, du rythme cardiaque, de la pression artérielle et elle est souvent en association avec une amplitude respiratoire accrue. Tous ces événements peuvent être décrits dans le contexte d’un micro-éveil du sommeil. Cette thèse comprend quatre articles de recherche visant à étudier i) l'étiologie de l’ARMM pendant le sommeil en relation aux micro-éveils, et à évaluer ii) les aspects cliniques du bruxisme du sommeil, du point de vue diagnostique et thérapeutique. Pour approfondir l'étiologie de l’ARMM et son association avec la fluctuation des micro-éveils, nous avons analysé le patron cyclique alternant (ou cyclic alternating pattern (CAP) en anglais), qui est une méthode d’analyse qui permet d’évaluer l'instabilité du sommeil et de décrire la puissance des micro-éveils. Le CAP a été étudié chez des sujets bruxeurs et des sujets contrôles qui ont participé à deux protocoles expérimentaux, dans lesquels la structure et la stabilité du sommeil ont été modifiées par l'administration d'un médicament (la clonidine), ou avec l'application de stimulations sensorielles (de type vibratoire/auditif) pendant le sommeil. Dans ces deux conditions expérimentales caractérisées par une instabilité accrue du sommeil, nous étions en mesure de démontrer que les micro-éveils ne sont pas la cause ou le déclencheur de l’ARMM, mais ils représentent plutôt la «fenêtre permissive» qui facilite l'apparition de ces mouvements rythmiques au cours du sommeil. Pour évaluer la pertinence clinique du bruxisme, la prévalence et les facteurs de risque, nous avons effectué une étude épidémiologique dans une population pédiatrique (7-17 ans) qui était vue en consultation en orthodontie. Nous avons constaté que le bruxisme est un trouble du sommeil très fréquent chez les enfants (avec une prévalence de 15%), et il est un facteur de risque pour l'usure des dents (risque relatif rapproché, RRR 8,8), la fatigue des muscles masticateurs (RRR 10,5), les maux de tête fréquents (RRR 4,3), la respiration bruyante pendant le sommeil (RRR 3,1), et divers symptômes liés au sommeil, tels que la somnolence diurne (RRR 7,4). Ces résultats nous ont amenés à développer une étude expérimentale pour évaluer l'efficacité d'un appareil d'avancement mandibulaire (AAM) chez un groupe d'adolescents qui présentaient à la fois du bruxisme, du ronflement et des maux de tête fréquents. L'hypothèse est que dans la pathogenèse de ces comorbidités, il y a un mécanisme commun, probablement lié à la respiration pendant le sommeil, et que l'utilisation d'un AAM peut donc agir sur plusieurs aspects liés. À court terme, le traitement avec un AAM semble diminuer l'ARMM (jusqu'à 60% de diminution), et améliorer le ronflement et les maux de tête chez les adolescents. Cependant, le mécanisme d'action exact des AAM demeure incertain; leur efficacité peut être liée à l'amélioration de la respiration pendant le sommeil, mais aussi à l'influence que ces appareils pourraient avoir sur le système masticatoire. Les interactions entre le bruxisme du sommeil, la respiration et les maux de tête, ainsi que l'efficacité et la sécurité à long terme des AAM chez les adolescents, nécessitent des études plus approfondies.