Analyse des effets du vieillissement cérébral normal sur l'excitabilité et la plasticité motrices corticales par la stimulation magnétique transcrânienne

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Income Inequality Trends in sub-Saharan Africa: Divergence, determinants and consequences: Social Protection and Inequality in Africa: Exploring the interactions

The World Bank (2015) reports that, in 2014, almost 1.9 billion individuals in the developing world – roughly one-third of the population in these countries – benefitted from social protection programmes. This is disproportionately driven by the size of the programmes in large countries such as China and India. The World Bank estimates that nearly one-third of individuals in the developing world receive benefits from a social protection programme. This compares favourably with the estimated average coverage rate of 25.0 per cent in SSA. The latter suggests that approximately 250 million individuals in SSA are beneficiaries of some form of social protection programme, almost equivalent to the number of beneficiaries of India’s National Rural Employment Guarantee Act (NREGA)

Neuralgic amyotrophy triggered by hepatitis E virus: a particular phenotype

International audienceObjective: The neuralgic amyotrophy may be of difficult diagnosis, due to phenotypic variability, with different initial presentations (upper plexus multiple mononeuropathy, lumbosacral involvement, distal reached, phrenic involvement). To date, there is little guidance on these patients’ therapeutic management, especially those for which neuralgic amyotrophy is triggered by hepatitis E virus (HEV-NA). The study aims to identify specific features that characterize patients bearing the neuralgic amyotrophy triggered by HEV. Methods: We first describe a new case report of HEV-neuralgic amyotrophy, with delayed diaphragmatic reach. Then, the literature was searched for reports of HEV-NA (n=39), and neuralgic amyotrophy with phrenic paresis (n=42) from 1999 to June 2016. Relevant data were retrieved, analyzed and compared with the parameters of idiopathic neuralgic amyotrophy (n=199) of the largest cohort, described by Van Alfen and Van Engelen in 2006. Results: Compared to the published cohort, HEV-NA patients were more likely to be men (M/F 34/5 versus 136/ 63, p=0.017), with more frequent bilateral symptoms (86.8% cases versus 28.5%, p<0.0001) as well as phrenic paresis (18.0% versus 6.6%, p=0.028). The clinical improvement is poor, with 15.6% of cases with remission only. Conclusions: A particular phenotype characteristic of the HEV-induced neuralgic amyotrophy has arisen. Our findings call for action in validating the above mentioned features that illustrate the HEV-NA cases as an early diagnosis would prevent complications, especially the phrenic damage often associated with a worse functional outcome

Writing tremor: Should we look for a TOR1A mutation

International audienc

Neuropathie motrice périphérique et maladie de Pompe : association fortuite ?

Le cas suivant a été présenté le 20 mars 2019 à Paris lors de la Journée Annuelle de la Maladie de Pompe. Il s’agit d’un patient admis en réanimation pour une détresse respiratoire aiguë liée à une atteinte sévère du muscle diaphragmatique. L’EMG réalisé lors de cette première hospitalisation était compatible avec une neuropathie motrice démyélinisante auto-immune. Quelques années plus tard, devant la persistance de CPK subnormales et d’un tableau respiratoire toujours sévère, un dosage de l’activité maltase acide a été proposé. Le diagnostic de maladie de Pompe est alors posé

Exhaustive, one-year follow-up of subthalamic nucleus deep brain stimulation in a large, single-center cohort of parkinsonian patients.

International audienceOBJECTIVE: To prospectively assess the impact of subthalamic nucleus (STN) deep brain stimulation (DBS) at 12 months after surgery in a series of 100 consecutive patients treated in a single center. The primary objective was to describe the clinical outcome in terms of efficacy and tolerance in STN-DBS patients. A secondary objective was to discuss presurgery clinical characteristics a posteriori as a function of outcome. METHODS: One hundred and three consecutive patients with severe Parkinson's disease received bilateral STN-DBS in our clinic between May 1998 and March 2003. Clinical assessment was performed before and 12 months after surgery and was based on the Unified Parkinson's Disease Rating Scale, Parts II, III, and IV A; the Schwab and England Scale; and cognitive evaluation. Patient-rated overall improvement was also evaluated. RESULTS: Twelve months after surgery, the Unified Parkinson's Disease Rating Scale Part III score decreased by 43%, the Unified Parkinson's Disease Rating Scale Part II score (activities of daily living) fell by 34%, and the severity of dyskinesia-related disability decreased by 61%. The main surgical complications after STN-DBS were as follows: infection (n = 7), intracerebral hematoma (n = 5), electrode fracture (n = 4), and incorrect lead placement (n = 8). We observed cognitive decline and depression in 7.7 and 18% of the patients, respectively. The mean patient-rated overall improvement score was 70.7%. CONCLUSION: The efficacy and safety of STN-DBS in our center's large cohort of Parkinsonian patients are generally similar to the results obtained by other groups, albeit at the lower limit of the range of reported values. In contrast to efficacy, the occurrence of adverse events cannot be predicted. Younger patients with Parkinson's disease (i.e., those younger than 60 yr) often show an excellent response to levodopa. However, in view of our data on overall patient satisfaction and the occurrence of adverse events, we suggest that older patients (but not those older than 70 yr) and less dopa-sensitive patients (but not those with a response <50%) should still be offered the option of STN-DBS

Effects of pulse width variations in pallidal stimulation for primary generalized dystonia.

International audienceBACKGROUND: Various pulse widths (from 60-450 mus) have been used for bilateral pallidal stimulation in generalized dystonia but, to date, no comparison of this parameter's effects is available. OBJECTIVE: To provide an analysis of the differential effects of bilateral short, medium and long stimulus pulse width (PW) on clinical improvement in primary generalized dystonia. METHODS: The most effective therapeutic stimulation parameters were recorded in 22 patients using bilateral pallidal stimulation. Six months after surgery, the effects of bilateral pallidal short (60-90 micros), medium (120-150 micros) and long (450 micros) PWs were studied in 20 of those patients. The effect of the stimulation was assessed by reviewing videotaped sessions by an observer blinded to treatment status (Burke-Fahn-Marsden movement score). Patients were tested on separate days, in random order, for the stimulation conditions (acute effect with the stimulation condition lasting 10 hours). The same contact was used for each stimulation condition. All the electrodes were set at 130 Hz (monopolar stimulation) and the intensity was set individually 10% below the side effect threshold. RESULTS: Median PWs of 60 (short), 120 (medium) and 450 micros (long) were compared,with a mean intensity of 4.46, 3.45 and 2.47 V, respectively. This study failed to demonstrate any significant difference in the movement scale dystonia mean scores depending on PW. CONCLUSION: According to our findings, short duration stimulus PWs are as effective as longer ones during a 10 hour period of observation. Confirmation of this finding for chronic use could be of importance in saving stimulator energy. Moreover, the use of smaller stimulus pulse widths are said to reduce charge injection and increase the therapeutic window between therapeutic effects and side effects

Human Fetal Cell Therapy in Huntington's Disease: A Randomized, Multicenter, Phase II Trial

info:eu-repo/semantics/publishe

Human Fetal Cell Therapy in Huntington's Disease: A Randomized, Multicenter, Phase II Trial

International audienceBackground: Huntington s disease is a ' rare, severe, inherited neurodegenerative disease in which we assessed the safety and efficacy of grafting human fetal ganglionic eminence intrastriatally. Methods: Patients at the early stage of the di sease were enrolled in the Multicentric Intracerebral Grafting in Huntington's Disease trial, a delayed-start phase II randomized study. After a run-in period of 12 m onths, patients were randomized at month 12 to either the treatment group (transplanted at month 13-mo nth 14) or the control group and secondarily treated 20 months later (month 33-month 34). The primary outcome was total motor score compared between both groups 20 months postrandomization (month 32). Secondary outcomes i ncluded clinical, imaging, and electrophysiological findings and a comparison of pregraft and p ostgraft total motor score slopes durin g th e entire study period (month 0-month 52) regardless of the time of transplant. Results: Of 54 randomized patients, 45 were transplanted; 26 immediately (treatment) and 19 delayed (control). Mean total motor score at month 32 did not differ between groups (treated controls difference in means adjusted for M12: +2.9 [95% confidence interval, −2.8 to 8.6]; = 0.31). Its rate of decline after transplan-P tation was similar to that before transplantation. A total of 27 severe adverse events were recorded in the randomized patients, 10 of which were related to the transplant procedure. Improvement of procedures during the trial significantly decreased the frequency of surgical events.We found antihuman leucocytes antigen antibodies in 40% of the patients. Conclusion: No clinical benefit was found in this trial. This may have been related to graft rejection. Ectopia and high track number negatively influence the graft outcome. Procedural adjustments substantially improved surgical safety. (ClinicalTrials.gov NCT00190450