Long-term outcomes of CLIPPERS (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) in a consecutive series of 12 patients.

BACKGROUND: Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a central nervous system inflammatory disease. OBJECTIVE: To describe the disease course of CLIPPERS. DESIGN: A nationwide study was implemented to collect clinical, magnetic resonance imaging, cerebrospinal fluid, and brain biopsy specimen characteristics of patients with CLIPPERS. SETTING: Academic research. PATIENTS: Twelve patients with CLIPPERS. MAIN OUTCOME MEASURES: The therapeutic management of CLIPPERS was evaluated. RESULTS: Among 12 patients, 42 relapses were analyzed. Relapses lasted a mean duration of 2.5 months, manifested frequent cerebellar ataxia and diplopia, and were associated with a mean Expanded Disability Status Scale (EDSS) score of 4. Besides typical findings of CLIPPERS, magnetic resonance imaging showed brainstem mass effect in 5 patients, extensive myelitis in 3 patients, and closed ring enhancement in 1 patient. Inconstant oligoclonal bands were found on cerebrospinal fluid investigation in 4 patients, with an increased T-cell ratio of CD4 to CD8. Among 7 available brain biopsy specimens, staining was positive for perivascular CD4 T lymphocytes in 5 samples. Thirty-eight of 42 relapses were treated with pulse corticosteroid therapy, which led to improvement, with a mean residual EDSS score of 1.9 (range, 0-7). In 1 patient with untreated relapses, scores on the EDSS progressively increased to a score of 10 at death. Among 5 patients without long-term corticosteroid therapy, the mean annualized relapse rate was 0.5 (range, 0.25-2.8). Among 7 patients taking oral corticosteroids, no relapses occurred in those whose daily dose was 20 mg or higher. No progressive course of CLIPPERS was observed. Four patients with a final EDSS score of 4 or higher had experienced previous severe relapses (EDSS score, ≥5) and brainstem and spinal cord atrophy. CONCLUSIONS: CLIPPERS is a relapsing-remitting disorder without progressive forms. Long-term disability is correlated with the severity of previous relapses. Further studies are needed to confirm that prolonged corticosteroid therapy prevents further relapses.journal article2012 Julimporte

Tentativa de conceptualización tridimensional de la cohesión: aplicación al baloncesto

The main objective of the research was to assimilate the concept of cohesion in a three-dimensional way. It was conducted over 48 basketball players, ages ranging from 18 to 37, from four basketball teams participating in E.B.A League (Spain). The sociometric questionnaire (Moreno, 1934) was filled in by players from each team at the end of championship. At the same time, teams were observed in official game and practice situation. Besides, test results check out was followed by a meeting with each coach. The present findings confirm that high performance levels coincide with high cohesion rates. We made obvious that (1) hierarchical aspect is an intrinsic to cohesion (Cota et al., 1995 ; Dion, 2000); (2) there are congruent areas for the three dimensions which constitute cohesion (functional / social; social / hierarchical; hierarchical / functional; functional / social / hierarchical); and (3) given this construct, a way measuring cohesion level for each one of the teams. We suggest future researches, taking into consideration the converge of the following points of view: the �Group Environnement Questionnaire� (Carron, Widmeyer and Brawley, 1985), Sociometric paradigm (Moreno, 1954) and �Scale Categorization Theory� (Turner et al., 1987); with the intention of coordinating them so that we can understand groups phenomena in a wider way.O objetivo do presente estudo é considerar o conceito de coesão de maneira tridimensional. A amostra é formada por quatro equipes de basquete de 48 jogadores, os quais têm entre 18 e 37 anos e jogam na Liga EBA (Espanha). Foi administrado o questionário sociométrico (Moreno, 1934) aos jogadores de cada equipe ao final do campeonato. Paralelamente, se observou as equipes em situação de competição (partida oficial), de treinamento, e além, a análise dos resultados deu lugar a entrevistas com cada um dos treinadores. Os resultados encontrados confirmam que níveis elevados de rendimento coincidem com os índices de coesão elevados. Se evidenciou que (1) o aspecto hierárquico da coesão é uma dimensão intrínseca (Cota et al., 1995; Dion, 2000); (2) as três dimensões constitutivas da coesão apresentam zonas comuns (funcional/social; social/hierárquico; hierárquico/funcional; funcional/social/ hierárquico), e (3) uma forma de medir nível de coesão a partir da análise sociométrica. Se sugere a partir do presente trabalho que em futuros estudos se leve em conta a correlação dos seguintes instrumentos: o �Group Environnement Questionnaire� (Carron, Widmeyer e Brawley, 1985), o paradigma sociométrico (Moreno, 1954) e o �Scale Categorization Theory� (Turner et al., 1987) com vistas de relacioná-los entre sr, de maneira que nos permita compreender melhor os fenómenos de grupo.El objetivo del presente estudio es considerar el concepto de cohesión de manera tridimensional. La muestra está formada por cuatro equipos de baloncesto de 48 jugadores, los cuales tienen entre 18 y 37 años y juegan en la Liga EBA (España). Se administró el cuestionario sociométrico (Moreno, 1934) a los jugadores de cada equipo al final del campeonato. Paralelamente, se observó a los equipos en situación de competición (partido oficial), de entrenamiento, y además, el escrutinio de los resultados dio lugar a entrevistas con cada uno de los entrenadores. Los resultados encontrados confirman que unos niveles elevados de rendimiento coinciden con unos índices de cohesión elevados. Se evidenció que (1) el aspecto jerárquico de la cohesión es una dimensión intrínseca (Cota et al., 1995; Dion, 2000); (2) las tres dimensiones constitutivas de la cohesión presentan zonas comunes (funcional/social; social/jerárquico; jerárquico/funcional; funcional/social/jerárquico), y (3) una forma de medir el nivel de cohesión a partir del análisis sociométrico. Se sugiere a partir del presente trabajo que en futuros estudios se tenga en cuenta el cruce de los siguientes instrumentos: el �Group Environnement Questionnaire� (Carron, Widmeyer y Brawley, 1985), el paradigma sociométrico (Moreno, 1954) y el �Scale Categorization Theory� (Turner et al., 1987) con vistas a relacionarlos entre sí, de manera que nos permita comprender mejor los fenómenos grupales

Subthalamic stimulation: toward a simplification of the electrophysiological procedure.

International audienceThe aim of the present study was to assess the consequences of a simplification of the electrophysiological procedure on the post-operative clinical outcome after subthalamic nucleus implantation in Parkinson disease

Does early verbal fluency decline after STN implantation predict long-term cognitive outcome after STN-DBS in Parkinson's disease?

International audienceBackgrounds: An early and transient verbal fluency (VF) decline and impairment in frontal executive function, suggesting a cognitive microlesion effect may influence the cognitive repercussions related to subthalamic nucleus deep brain stimulation (STN-DBS.)Methods: Neuropsychological tests including semantic and phonemic verbal fluency were administered both before surgery (baseline), the third day after surgery (T3), at six months (T180), and at an endpoint multiple years after surgery (Tyears). Results: Twenty-four patients (mean age, 63.5 ± 9.5 years; mean disease duration, 12 ± 5.8 years) were included. Both semantic and phonemic VF decreased significantly in the acute post-operative period (44.4 ± 28.2 and 34.3 ± 33.4, respectively) and remained low at 6 months compared to pre-operative levels (decrease of 3.4 ± 47.8% and 10.8 ± 32.1%) (P < 0.05). Regression analysis showed phonemic VF to be an independent factor of decreased phonemic VF at six months. Age was the only independent predictive factor for incident Parkinson's disease dementia (PDD) (F (4,19) = 3.4, P <0.03).Conclusion: An acute post-operative decline in phonemic VF can be predictive of a long-term phonemic VF deficit. The severity of this cognitive lesion effect does not predict the development of dementia which appears to be disease-related

Clavicle fracture mimicking dropped-head syndrome in a patient with multiple system atrophy

International audienceDropped-head syndrome is characterized by an abnormal ante-fixed posture of the neck, usually observed in patients with neurodegenerative disorders such as multiple system atrophy (MSA) [1]. We report an unusual cause of acute antero- and latero-collis in a patient with MSA

Indomethacin-Responsive Paroxysmal Hemicrania in an Elderly Man: An Unusual Presentation of Pituitary Apoplexy

International audienc

Pre-operative obesity may influence subthalamic stimulation outcome in Parkinson's disease

International audienc

Decline in verbal fluency after subthalamic nucleus deep brain stimulation in Parkinson's disease: a microlesion effect of the electrode trajectory?

International audienceDecline in verbal fluency (VF) is frequently reported after chronic deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson disease (PD)

Accuracy of the robot‐assisted procedure in deep brain stimulation

International audienc

Does Bilateral Deep Brain Stimulation of the Subthalamic Nucleus Modify Ano‐Rectal Motility in Parkinson's Disease? Results of a Randomized Cross‐Over Study

International audienc