Switching of smooth pursuit in humans : towards an understanding of the constitution of internal model of an "external moving object"

Afin de poursuivre une cible en mouvement, le système nerveux central (SNC) utilise deux types de mouvements oculaires: la poursuite et les saccades. Les saccades sont des mouvements rapides et brefs de redirection de l’axe visuel d’un centre d’intérêt à un autre. La poursuite est un mouvement lent qui tend à maintenir la cible d’intérêt sur la fovéa. La vitesse de l’œil étant toujours inférieure à celle de la cible, une erreur positionnelle entre l’œil et la cible va croître en l’absence de mouvement correctif. Des saccades de rattrapage sont déclenchées par le SNC pour corriger cette erreur. Alors qu’il est largement reconnu que le système de la poursuite utilise un modèle interne du mouvement de la cible pour améliorer ses capacités, la modalité de contrôle de l’amplitude des saccades de rattrapage est sujette à controverse quant au rôle direct d’afférences sensorielles ou d’un modèle interne de la cible en mouvement. Nous avons développé un nouveau paradigme de transition de poursuite oculaire appliqué à l’Homme sain, dans lequel la cible change de manière imprévisible d’un profil de vitesse non constant périodique à un profil de vitesse non constant apériodique. Nos résultats confirment que le SNC utilise un modèle interne de la cible en mouvement pour contrôler l’amplitude des saccades de rattrapage. Ce modèle se construit progressivement à partir de 168 millisecondes après le changement de profil de vitesse et est utilisé conjointement par les systèmes de la poursuite et saccadique. Le substrat neuronal potentiel de ce modèle interne sera discuté à la lumière des connaissances issues de la littérature concernant le contrôle moteur et oculomoteur.Two types of eye movements are combined while tracking a moving object: smooth pursuit and saccades. Saccades are rapid redirections of the visual axis between two centers of interest. Because pursuit gain is smaller than one, the eye would increasingly lag behind the target without any correcting movements. Thus, “catch-up saccades” are triggered by the central nervous system (CNS) to cancel this growing position error between the eye and the target. It is widely accepted that an internal model of target motion is used by the CNS to cancel inherent delays between visual input and smooth pursuit motor output, ensuring accurate tracking of moving targets. The amplitude of catch-up saccades triggered during smooth pursuit could be corrected by a delayed sensory signal to account for the ongoing target displacement during catch-up saccades. Yet, recent studies suggested that the correction of catch-up saccade amplitude must also be done through an internal model of target motion. We developed a new paradigm in which the target switches unexpectedly from one target with a non-constant periodic velocity profile to another with a non-constant aperiodic velocity profile. Our results in healthy humans confirm that the CNS uses an internal model of target motion to correct catch-up saccade amplitude. Internal model is being built gradually from 168 ms after the target switch. We show that a common internal model of target motion is shared within the CNS to control smooth pursuit and to correct catch-up saccade amplitude. The potential neuronal substrate of such an internal model will be discussed in the light of the knowledge from the literature on motor and oculomotor control

Facteurs prédictifs de l'évolution de la forme rémittente de sclérose en plaques

CAEN-BU Médecine pharmacie (141182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Experimental Testing of Passive Linear TMD for Postural Tremor Attenuation

International audienceResearch interest to provide a mechanical solution for involuntary tremors is increasing due to the severe side effects caused by the medications used to lessen its symptoms. This paper deals with the design of a cantilever-type tuned mass damper (TMD) used to prove the effectiveness of passive controllers in reducing the involuntary tremor’s vibrational signals transmitted by the muscles to the hand segment. TMD is tested on an experimental arm, reflecting the flexion-extension motion of the wrist, excited by a mechanical shaker with the measured tremor signal of a patient with essential tremor. The designed TMD provides a new operational frequency for each position of the screw fixed to its beam. Modal damping ratios are also calculated using different methods for each position. The effectiveness of the TMD is quantified by measurements using a vibrometer and inertial measurement unit. Three TMDs, representing 15.7% total mass ratio, cause a reduction of 29% for the acceleration, 69% for the velocity, 79% for the displacement, 67% for the angular velocity, and 82% for the angular displacement signals. These encouraging results will allow the improvement of the design of the passive controller in the form of a wearable bracelet suitable for daily lif

New insight in spiral drawing analysis methods – Application to action tremor quantification

International audienceObjective: Spiral drawing is one of the standard tests used to assess tremor severity for the clinical evaluation of medical treatments. Tremor severity is estimated through visual rating of the drawings by movement disorders experts. Different approaches based on the mathematical signal analysis of the recorded spiral drawings were proposed to replace this rater dependent estimate. The objective of the present study is to propose new numerical methods and to evaluate them in terms of agreement with visual rating and reproducibility. Methods: Series of spiral drawings of patients with essential tremor were visually rated by a board of experts. In addition to the usual velocity analysis, three new numerical methods were tested and compared, namely static and dynamic unraveling, and empirical mode decomposition. The reproducibility of both visual and numerical ratings was estimated, and their agreement was evaluated. Results: The statistical analysis demonstrated excellent agreement between visual and numerical ratings, and more reproducible results with numerical methods than with visual ratings. Conclusions: The velocity method and the new numerical methods are in good agreement. Among the latter, static and dynamic unravelling both display a smaller dispersion and are easier for automatic analysis. Significance: The reliable scores obtained through the proposed numerical methods allow considering that their implementation on a digitized tablet, be it connected with a computer or independent, provides an efficient automatic tool for tremor severity assessment

A clinical and neurophysiological motor signature of Unverricht–Lundborg disease

International audienceObjectives: Unverricht–Lundborg disease (ULD) is the most common form of progressive myoclonus epilepsy. Cerebellar dysfunction may appear over time, contributing along with myoclonus to motor disability. The purpose of the present work was to clarify the motor and neurophysiological characteristics of ULD patients.Methods: Nine patients with genetically proven ULD were evaluated clinically (medical history collected from patient charts, the Scale for the Assessment and Rating of Ataxia and Unified Myoclonus Rating Scale). Neurophysiological investigations included EEG, surface polymyography, long-loop C-reflexes, somatosensory evoked potentials, EEG jerk-locked back-averaging (JLBA) and oculomotor recordings. All patients underwent brain MRI. Non-parametric Mann-Whitney tests were used to compare ULD patients’ oculomotor parameters with those of a matched group of healthy volunteers (HV).Results: Myoclonus was activated by action but was virtually absent at rest and poorly induced by stimuli. Positive myoclonus was multifocal, often rhythmic and of brief duration, with top-down pyramidal temporospatial propagation. Cortical neurophysiology revealed a transient wave preceding myoclonus on EEG JLBA (n = 8), enlarged somatosensory evoked potentials (n = 7) and positive long-loop C-reflexes at rest (n = 5). Compared with HV, ULD patients demonstrated decreased saccadic gain, increased gain dispersion and a higher frequency of hypermetric saccades associated with decreased peak velocity.Conclusion: A homogeneous motor pattern was delineated that may represent a ULD clinical and neurophysiological signature. Clinical and neurophysiological findings confirmed the pure cortical origin of the permanent myoclonus. Also, oculomotor findings shed new light on ULD pathophysiology by evidencing combined midbrain and cerebellar dysfunction

Long-term follow-up in an open-label trial of triheptanoin in GLUT1 deficiency syndrome: a sustained dramatic effect

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Freezing of gait depends on cortico-subthalamic network recruitment following STN-DBS in PD patients

Introduction: Subthalamic deep-brain-stimulation (STN-DBS) is an effective means to treat Parkinson's disease (PD) symptoms. Its benefit on gait disorders is variable, with freezing of gait (FOG) worsening in about 30% of cases. Here, we investigate the clinical and anatomical features that could explain postoperative FOG. Methods: Gait and balance disorders were assessed in 19 patients, before and after STN-DBS using clinical scales and gait recordings. The location of active stimulation contacts were evaluated individually and the volumes of activated tissue (VAT) modelled for each hemisphere. We used a whole brain tractography template constructed from another PD cohort to assess the connectivity of each VAT within the 39 Brodmann cortical areas (BA) to search for correlations between postoperative PD disability and cortico-subthalamic connectivity. Results: STN-DBS induced a 100% improvement to a 166% worsening in gait disorders, with a mean FOG decrease of 36%. We found two large cortical clusters for VAT connectivity: one "prefrontal", mainly connected with BA 8,9,10,11 and 32, and one "sensorimotor", mainly connected with BA 1-2-3,4 and 6. After surgery, FOG severity positively correlated with the right prefrontal VAT connectivity, and negatively with the right sensorimotor VAT connectivity. The right prefrontal VAT connectivity also tended to be positively correlated with the UPDRS-III score, and negatively with step length. The MDRS score positively correlated with the right sensorimotor VAT connectivity. Conclusion: Recruiting right sensorimotor and avoiding right prefrontal cortico-subthalamic fibres with STN-DBS could explain reduced post-operative FOG, since gait is a complex locomotor program that necessitates accurate cognitive control

Triheptanoin dramatically reduces paroxysmal motor disorder in patients with GLUT1 deficiency

International audienceObjective On the basis of our previous work with triheptanoin, which provides key substrates to the Krebs cycle in the brain, we wished to assess its therapeutic effect in patients with glucose transporter type 1 deficiency syndrome (GLUT1-DS) who objected to or did not tolerate ketogenic diets.Methods We performed an open-label pilot study with three phases of 2 months each (baseline, treatment and withdrawal) in eight patients with GLUT1-DS (7–47 years old) with non-epileptic paroxysmal manifestations. We used a comprehensive patient diary to record motor and non-motor paroxysmal events. Functional 31P-NMR spectroscopy was performed to quantify phosphocreatine (PCr) and inorganic phosphate (Pi) within the occipital cortex during (activation) and after (recovery) a visual stimulus.Results Patients with GLUT1-DS experienced a mean of 30.8 (±27.7) paroxysmal manifestations (52% motor events) at baseline that dropped to 2.8 (±2.9, 76% motor events) during the treatment phase (p=0.028). After withdrawal, paroxysmal manifestations recurred with a mean of 24.2 (±21.9, 52% motor events; p=0.043). Furthermore, brain energy metabolism normalised with triheptanoin, that is, increased Pi/PCr ratio during brain activation compared to the recovery phase (p=0.021), and deteriorated when triheptanoin was withdrawn.Conclusions Treatment with triheptanoin resulted in a 90% clinical improvement in non-epileptic paroxysmal manifestations and a normalised brain bioenergetics profile in patients with GLUT1-DS

Preoperative REM Sleep Behavior Disorder and Subthalamic Nucleus Deep Brain Stimulation Outcome in Parkinson Disease 1 Year After Surgery

International audienceBackground and Objectives To determine whether patients with Parkinson disease (PD) eligible for subthalamic nucleus deep brain stimulation (STN-DBS) with probable REM sleep behavior disorder (RBD) preoperatively could be more at risk of poorer motor, nonmotor, and quality of life outcomes 12 months after surgery compared to those without RBD.Methods We analyzed the preoperative clinical profile of 448 patients with PD from a French multicentric prospective study (PREDISTIM) according to the presence or absence of probable RBD based on the RBD Single Question and RBD Screening Questionnaire. Among the 215 patients with PD with 12 months of follow-up after STN-DBS, we compared motor, cognitive, psycho-behavioral profile, and quality of life outcomes in patients with (pre-opRBD+) or without (pre-opRBD–) probable RBD preoperatively.Results At preoperative evaluation, pre-opRBD+ patients were older (61 ± 7.2 vs 59.5 ± 7.7 years; p = 0.02), had less motor impairment (Movement Disorder Society–sponsored version of the Unified Parkinson’s Disease Rating Scale [MDS-UPDRS] III “off”: 38.7 ± 16.2 vs 43.4 ± 7.1; p = 0.03) but more nonmotor symptoms on daily living activities (MDS-UPDRS I: 12.6 ± 5.5 vs 10.7 ± 5.3; p < 0.001), had more psychobehavioral manifestations (Ardouin Scale of Behavior in Parkinson's Disease total: 7.7 ± 5.1 vs 5.1 ± 0.4; p = 0.003), and had worse quality of life (Parkinson's Disease Questionnaire–39: 33 ± 12 vs 29 ± 12; p = 0.03), as compared to pre-opRBD– patients. Both pre-opRBD+ and pre-opRBD– patients had significant MDS-UPDRS IV score decrease (−37% and −33%, respectively), MDS-UPDRS III “med ‘off’/stim ‘on’” score decrease (−52% and −54%), and dopaminergic treatment decrease (−52% and −49%) after surgery, with no between-group difference. There was no between-group difference for cognitive and global quality of life outcomes.Conclusions In patients with PD eligible for STN-DBS, the presence of probable RBD preoperatively is not associated with a different clinical outcome 1 year after neurosurgery. Trial Registration Information NCT02360683.Classification of Evidence This study provides Class II evidence that in patients with PD eligible for STN-DBS, the presence of probable RBD preoperatively is not associated with poorer outcomes 1 year post surgery

A randomized, controlled, double-blind, crossover trial of triheptanoin in alternating hemiplegia of childhood

Abstract Background Based on the hypothesis of a brain energy deficit, we investigated the safety and efficacy of triheptanoin on paroxysmal episodes in patients with alternating hemiplegia of childhood due to ATP1A3 mutations. Methods We conducted a randomized, double-blind, placebo-controlled crossover study of triheptanoin, at a target dose corresponding to 30% of daily calorie intake, in ten patients with alternating hemiplegia of childhood due to ATP1A3 mutations. Each treatment period consisted of a 12-week fixed-dose phase, separated by a 4-week washout period. The primary outcome was the total number of paroxysmal events. Secondary outcomes included the number of paroxysmal motor-epileptic events; a composite score taking into account the number, severity and duration of paroxysmal events; interictal neurological manifestations; the clinical global impression-improvement scale (CGI-I); and safety parameters. The paired non-parametric Wilcoxon test was used to analyze treatment effects. Results In an intention-to-treat analysis, triheptanoin failed to reduce the total number of paroxysmal events (p = 0.646), including motor-epileptic events (p = 0.585), or the composite score (p = 0.059). CGI-I score did not differ between triheptanoin and placebo periods. Triheptanoin was well tolerated. Conclusions Triheptanoin does not prevent paroxysmal events in Alternating hemiplegia of childhood. We show the feasibility of a randomized placebo-controlled trial in this setting. Trial registration The study has been registered with clinicaltrials.gov ( NCT002408354 ) the 03/24/2015