Narcolepsie et qualité de vie

CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Weight gain mecanisms after deep brain stimulation of the subthalamic nucleus in Parkinson’s disease patients

Weight gain mecanisms after deep brain stimulation of the subthalamic nucleus in Parkinson’s disease patients. 10. International Congress of Parkinson's Disease and Movement Disorder

Stimulation thalamique chronique pour le contrôle du tremblement réfractaire: apport de l’IRM 1.5 Tesla en séquence WAIR pour le ciblage direct du Vim et l’analyse post opératoire des structures anatomiques potentiellement impliquées dans les effets

National audienc

Mechanisms of body weight gain in parkinson patients after subthalamic stimulation: implication of changes in energy expenditure

Mechanisms of body weight gain in parkinson patients after subthalamic stimulation: implication of changes in energy expenditure. 57. Annual Meeting of the American Academy of Neurolog

Comparison between atlas based diagrams used for indirect STN targeting and STN templates determined directly on stereotactic MRI

International audienceObjective. Stereotactic determination of the subthalamic nucleus (STN) target is based on diagrams (indirect statistical coordinates relatively to anterior and posterior commissures AC, PC) or on direct MRI visualization. We aimed to compare both methods.Methods. We studied 30 STN in 15 parkinsonian patients operated on for bilateral electrode placement. STN, AC and PC were identified on stereotactic 1.5-Tesla MRI slices (stereotactic frame in place; T2 weighted). We outlined STN boundaries on coronal slices. We defined a lateral template (hexagonal shape; on the sagittal slice where STN was widest) then 3 frontal templates (quadrilateral shape) located on the anterior, the intermediate and the posterior borders of lateral STN template. We built Guiot’s (modified by Benabid et al.) and Talairach’s STN diagrams. We tested discordance, using paired means comparisons, on locations of centres between STN diagrams and templates, for both frontal and lateral views.Results. There were significant differences (p<0.05) between diagrams and templates in laterality, in ACPC direction and in dorso-ventral direction, except for the anterior frontal template in the dorso-ventral direction. Schematically the lateral template was in a more posterior and ventral position and the frontal templates were in a more medial position. Considering only the indirect method, the locations of centres on frontal and on lateral diagrams, in the dorso-ventral direction, were significantly different.Conclusions. A slight translation of diagrams on lateral view would probably allow a better correspondence with STN directly defined on MRI. The shape of diagram used on frontal view could also be modified

Mécanismes de la prise de poids chez le patient parkinsonien après stimulation sous-thalamique : implication des modifications de la dépense énergétique

Mécanismes de la prise de poids chez le patient parkinsonien après stimulation sous-thalamique : implication des modifications de la dépense énergétique. 24.Congrès de la Société Francophone de Nutrition Entérale et Parentérale (SFNEP

Deep Brain Stimulation for Parkinson’s Disease: Anatomical Location of Effective Contacts in the Sub Thalamic Area

International audienceThe location of effective contacts during deep brain stimulation (DBS) is still debated in particular in the sub thalamic area.Objectives:To localise on 1.5 T MRI, the effective contacts in patients successfully treated for Parkinson’s disease by bilateral DBS of the sub thalamic nucleus (STN).Material and methods:Ten patients with excellent clinical outcome were analysed. The surgical procedure was based on direct targeting of the nucleus (anatomic targeting without reference to internal landmarks). The effective contacts were determined during the first 6 months following the implantation, i.e. those given the best efficacy on the clinical symptoms (mean improvement rate 82.5%, range 75.8–94.1%). The contact locations were retrospectively projected on the stereotactic 1.5 T MRI (3 sets, orthogonal plans), i.e. with a stereotactic frame. For each patient, we have distinguished the right and the left hemisphere. The location of the effective contacts was directly studied by visual comparison, between the 1.5 T images and an in-house 4.7 T MRI anatomic reference. The membership for a given structure was determined using the results for each orthogonal, independent plan.Results:The effective contact were located within the STN in 4 cases, at the interface of the STN and the zona incerta (ZI) and/or the Forel’s field (FF) in 12 cases, at the interface between ZI and FF in 3 cases, at the interface between the STN and the substantia nigra in one case.Discussion:The dorsolateral part of the STN is usually considered as the target for DBS in Parkinson’s disease. We discuss the role of adjacent structures, especially ZI and FF, in the clinical benefit. A largest study, including 56 patients is already in progress to assess and to refine these results

Mechanisms of body weight gain in parkinsonian patients after subthalamic stimulation: Implication of changes in energy expenditure

Mechanisms of body weight gain in parkinsonian patients after subthalamic stimulation: Implication of changes in energy expenditure. 8. International Congress of Parkinson's Disease and Movement Disorder

Stimulation du noyau sous-thalamique (DBS-STN) dans la maladie de Parkinson : quelle cible pour la meilleure efficacité ?

National audienceLa stimulation du noyau sous-thalamique est le traitement de référence des complications motrices persistantes, malgré les adaptations thérapeutiques chez le patient parkinsonien. La nature de la cible optimale au niveau de la région sous-thalamique en termes de bénéfice clinique et de tolérance reste discutée. Dans notre expérience, les contacts utilisés de façon chronique sont souvent différents que ceux sélectionnés au cours de la procédure chirurgicale. Nous avons donc réalisé une étude afin d'explorer systématiquement l'efficacité et la tolérance des 4 contacts (numérotés de 0 à 3, le contact 0 étant le plus profond) de chaque électrode chez 30 patients

Contribution of local field potential to subthalamic nucleus deep brain stimulation in Parkinson's disease

International audienceIntroduction: The subthalamic nucleus (STN) is the main target for deep brain stimulation (DBS) in Parkinson’s disease. We analyzed the relationships between magnetic resonance imaging (MRI) anatomy and electrophysiology (local field potential, LFP) done during surgery.Objectives: We hypothesized that the contribution of LFP to neuronal firing rate with detailed MRI anatomy should allow to explore finely anatomo-electrophysiological relationships and also to determine precisely functional surgical targets.Methods:Ten patients with Parkinson’s disease (5F; mean age: 62±4 years; 11±3 years disease duration) underwent bilateral STN DBS surgical procedure.Electrophysiology: 693 LFP recordings in MRI-outlined anatomical structures (Thalamus [Thal], Zona Incerta [ZI], Forel Field [Forel] and STN) were analyzed: Power spectral densities (PSD) from 0 to 100Hz; 1024 frequency values; Normalization: percent of total PSD; Calculation for delta (0-4 Hz), theta (4-7 Hz), alpha (7-13 Hz), beta (13-30 Hz), gamma (30-50 Hz, 50-100 Hz) frequency range. Non-parametric Kruskal-Wallis ANOVA tests were performed followed by pairwise comparisons with adjusted p-value.Results: Percentage of power spectral density for main physiological LFP frequency range was considered for thalamus, ZI, STN and Forel (Figure).Conclusions: This study suggests the interest of LFP to discriminate between structures in the subthalamic region using exploration electrode with patient at rest during DBS surgery. Another part of this study will consist in correlating extracellular neuronal activity and LFP, and analyzing modulations on LFP during voluntary movements of patients