La stimulation du noyau sous thalamique dans la maladie de Parkinson (évaluation clinique de 42 patients)

DIJON-BU Médecine Pharmacie (212312103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

How do scoliotic women shrink throughout life?

International audienceSTUDY DESIGN: Cross-sectional study among a population of scoliotic and nonscoliotic women aged 40 years or more with low back pain from a spine rehabilitation unit. OBJECTIVES: (1) To test the hypothesis that scoliotic (SW) women shrink faster than nonscoliotic women (NSW) in adulthood. (2) To investigate the effects of age and curve progression in the scoliotic group, and to develop a model to assess the natural history of scoliosis and shrinkage. SUMMARY OF BACKGROUND DATA: Little is known about the decrease in body height in adult scoliotic patients. A simple method to help predict the future course of the curvature in patients without radiograph follow-up could help clinicians make treatment decisions. METHODS: Sixty SW and 40 NSW women matched for age, with no history of vertebral fracture or osteoporosis, were questioned about their peak body height and measured. Total spine radiographs were performed, and compared with previous images if available. Correlations between self-reported peak body height and current height, shrinkage, age, time since menopause, and the Cobb angle were searched for. In women with documented radiograph follow-up, correlations between shrinkage and progression of the Cobb angle were sought to develop a predictive model of curve progression. RESULTS: Average shrinkage in the SW was twice that in the NSW (5.1 +/- 3.5 vs. 2.3 +/- 0.7 cm, P < 0.001), had begun early in adulthood, was due to the combined effect of age and scoliosis, and was strongly associated with rotatory olisthesis. In the 17 women with radiograph follow-up (19.7 +/- 7.3 years), curve progression was closely related to shrinkage (r = 0.74; P < 0.001; y = 0.7 + 2.7x; SE = 0.42). This allowed us to generate prediction limits of the scoliosis for a given individual. CONCLUSION: Determination of shrinkage could provide a simple, noninvasive, and cheap method to monitor the natural history of scoliosis in adults. It could therefore be used in routine clinical practice to help make treatment decisions for patients with no documented radiograph follow-up

Advanced Parkinson's disease effect on goal-directed and habitual processes involved in visuomotor associative learning

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Increased Risk of Parkinson's Disease in Women after Bilateral Oophorectomy

International audienceBackground: Results regarding the association between hormonal exposure and risk of Parkinson's disease (PD) are heterogeneous. Objectives: To investigate the association of reproductive life characteristics with PD among postmenopausal women. Methods: The PARTAGE case–control included 130 female cases and 255 age-matched female controls. Information on gynecological history was obtained from a standardized questionnaire and PD was validated by neurological examination. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using conditional logistic regression. Results: After adjustment for education level, smoking status, professional exposure to pesticides, and coffee and alcohol drinking, bilateral oophorectomy (OR = 3.55, 95%CI = 1.75–7.20), but neither menopause before age 50 years (OR = 1.24, 95%CI = 0.74–2.09) nor hormone therapy (HT; OR = 1.07, 95%CI = 0.62–1.86), was associated with PD. Conclusion: Our findings suggest that bilateral oophorectomy is associated with increased risk of PD

Quantification of Head Tremors in Medical Conditions: A Comparison of Analyses Using a 2D Video Camera and a 3D Wireless Inertial Motion Unit

International audienceThis study compares two methods to quantify the amplitude and frequency of head movements in patients with head tremor: one based on video-based motion analysis, and the other using a miniature wireless inertial magnetic motion unit (IMMU). Concomitant with the clinical assessment of head tremor severity, head linear displacements in the frontal plane and head angular displacements in three dimensions were obtained simultaneously in forty-nine patients using one video camera and an IMMU in three experimental conditions while sitting (at rest, counting backward, and with arms extended). Head tremor amplitude was quantified along/around each axis, and head tremor frequency was analyzed in the frequency and time-frequency domains. Correlation analysis investigated the association between the clinical severity of head tremor and head linear and angular displacements. Our results showed better sensitivity of the IMMU compared to a 2D video camera to detect changes of tremor amplitude according to examination conditions, and better agreement with clinical measures. The frequency of head tremor calculated from video data in the frequency domain was higher than that obtained using time-frequency analysis and those calculated from the IMMU data. This study provides strong experimental evidence in favor of using an IMMU to quantify the amplitude and time-frequency oscillatory features of head tremor, especially in medical conditions

Overview on wearable sensors for the management of Parkinson’s disease

Abstract Parkinson’s disease (PD) is affecting about 1.2 million patients in Europe with a prevalence that is expected to have an exponential increment, in the next decades. This epidemiological evolution will be challenged by the low number of neurologists able to deliver expert care for PD. As PD is better recognized, there is an increasing demand from patients for rigorous control of their symptoms and for therapeutic education. In addition, the highly variable nature of symtoms between patients and the fluctuations within the same patient requires innovative tools to help doctors and patients monitor the disease in their usual living environment and adapt treatment in a more relevant way. Nowadays, there are various body-worn sensors (BWS) proposed to monitor parkinsonian clinical features, such as motor fluctuations, dyskinesia, tremor, bradykinesia, freezing of gait (FoG) or gait disturbances. BWS have been used as add-on tool for patients’ management or research purpose. Here, we propose a practical anthology, summarizing the characteristics of the most used BWS for PD patients in Europe, focusing on their role as tools to improve treatment management. Consideration regarding the use of technology to monitor non-motor features is also included. BWS obviously offer new opportunities for improving management strategy in PD but their precise scope of use in daily routine care should be clarified

Symptoms assessment and decision to treat patients with advanced Parkinson’s disease based on wearables data

International audienceBody-worn sensors (BWS) could provide valuable information in the management of Parkinson’s disease and support therapeutic decisions based on objective monitoring. To study this pivotal step and better understand how relevant information is extracted from BWS results and translated into treatment adaptation, eight neurologists examined eight virtual cases composed of basic patient profiles and their BWS monitoring results. Sixty-four interpretations of monitoring results and the subsequent therapeutic decisions were collected. Relationship between interrater agreements in the BWS reading and the severity of symptoms were analyzed via correlation studies. Logistic regression was used to identify associations between the BWS parameters and suggested treatment modifications. Interrater agreements were high and significantly associated with the BWS scores. Summarized BWS scores reflecting bradykinesia, dyskinesia, and tremor predicted the direction of treatment modifications. Our results suggest that monitoring information is robustly linked to treatment adaptation and pave the way to loop systems able to automatically propose treatment modifications from BWS recordings information

Fatigue in de novo Parkinson's Disease: Expanding the Neuropsychiatric Triad?

BACKGROUND Fatigue is a frequent and troublesome symptom present from the early stages of Parkinson's disease (PD). OBJECTIVE To examine the relationship between fatigue and the neuropsychiatric triad, which includes apathy, depression, and anxiety, in de novo PD. METHODS We performed a cross-sectional study including 197 patients with de novo PD and assessed fatigue using the Parkinson's Disease Fatigue Scale (PDFS-16). We evaluated motor status using the Unified Parkinson's Disease Rating Scale (UPDRS) part III score and evaluated neuropsychiatric status using the Ardouin Scale of Behavior in Parkinson's Disease (ASBPD). We carried out univariate and multivariate analyses to model association between motor signs, non-motor signs, and fatigue risk. RESULTS Frequency of fatigue (28.9%) was of the same order of magnitude as that of apathy. PD patients with fatigue reported a lower quality of life than patients without fatigue (p < 0.0001). The ASBPD showed that patients with fatigue had higher scores for depressed mood (p < 0.0001), anxiety (p < 0.0001), and apathy (p < 0.0001). In the univariate analysis, fatigue score was positively correlated with apathy, depression, anxiety, and the neuropsychiatric triad as a whole, and to a lesser extent with female sex, hyperemotivity, and the UPDRS part III score. In the multivariate analysis, after adjusting for sex and motor status, the fatigue score remained significantly correlated with apathy (OR = 11.17 [4.33-28.78], p < 0.0001) and depression (OR = 4.28 [1.39-13.12], p = 0.01), but not with anxiety (OR = 0.94 [0.34-2.58], p = 0.9). CONCLUSION We propose that the neuropsychiatric triad could be expanded to include fatigue

Imbalanced motivated behaviors according to motor sign asymmetry in drug-naïve Parkinson’s disease

Abstract Few studies have considered the influence of motor sign asymmetry on motivated behaviors in de novo drug-naïve Parkinson’s disease (PD). We tested whether motor sign asymmetry could be associated with different motivated behavior patterns in de novo drug-naïve PD. We performed a cross-sectional study in 128 de novo drug-naïve PD patients and used the Ardouin Scale of Behavior in Parkinson’s disease (ASBPD) to assess a set of motivated behaviors. We assessed motor asymmetry based on (i) side of motor onset and (ii) MDS-UPDRS motor score, then we compared right hemibody Parkinson’s disease to left hemibody Parkinson’s disease. According to the MDS-UPDRS motor score, patients with de novo right hemibody PD had significantly lower frequency of approach behaviors (p = 0.031), including nocturnal hyperactivity (p = 0.040), eating behavior (p = 0.040), creativity (p = 0.040), and excess of motivation (p = 0.017) than patients with de novo left hemibody PD. Patients with de novo left hemibody PD did not significantly differ from those with de novo right hemibody PD regarding avoidance behaviors including apathy, anxiety and depression. Our findings suggest that motor sign asymmetry may be associated with an imbalance between motivated behaviors in de novo drug-naïve Parkinson’s disease