Hemi-spatial neglect rehabilitation using non-invasive brain stimulation: Or how to modulate the disconnection syndrome?

AbstractHemi-spatial neglect syndrome is common and sometimes long-lasting. It is characterized by a deficit in the use and awareness of one side of space, most often consecutive to a right hemisphere injury, mainly in the parietal region. Acknowledging the different types and all clinical characteristics is essential for an appropriate evaluation and adapted rehabilitation care management, especially as it constitutes a predictive factor of a poor functional prognosis. Some new approaches have been developed in the last fifteen years in the field of hemi-spatial neglect rehabilitation, where non-invasive brain stimulation (TMS and tDCS) holds an important place. Today's approaches of unilateral spatial neglect modulation via non-invasive brain stimulation are essentially based on the concept of inter-hemispheric inhibition, suggesting an over-activation of the contralesional hemisphere due to a decrease of the inhibiting influences of the injured hemisphere. Several approaches may then be used: stimulation of the injured right hemisphere, inhibition of the hyperactive left hemisphere, or a combination of both. Results are promising, but the following complementary aspects must be refined before a more systematic application: optimal stimulation protocol, individual management according to the injured region, intensity, duration and frequency of care management, delay post-stroke before the beginning of treatment, combination of different approaches, as well as prognostic and efficacy criteria. An encouraging perspective for the future is the combination of several types of approaches, which would be largely facilitated by the improvement of fundamental knowledge on neglect mechanisms, which could in the future refine the choice for the most appropriate treatment(s) for a given patient

Long-term change in nutritional status after severe traumatic brain injury

IntroductionIn the acute phase, patients who sustained a severe Traumatic Brain injury (TBI) (Glasgow Coma Scale under 8) frequently present malnutrition during critical care. Long-term nutritional outcome after a severe TBI has been less studied. Cognitive impairments and behavioural disorders together with hormonal disorders can lead to persisting malnutrition or over-eating and obesity. The purpose of this study was to follow the weight, the body mass index (BMI), albuminemia and hormonal dosage after a severe TBI.MethodsThis study relied on a research protocol designed to follow concurrently and prospectively endocrine disorders and cognitive disorders in a cohort of patients with severe TBI (Inspire-TC protocol). In the present work, we focused specifically on the evolution in weight, height, body mass index, albuminemia and endocrine abnormalities. These parameters were collected upon admission to the rehabilitation department, at 4 months, 12 months and 18 months when feasible for the severe TBI patients included in the Inspire-TC protocol. Albuminaemia was measured late after the TBI when patients agreed.Results10 patients were included. Initially 60% of the patients had biological malnutrition, 10% were overweight, 80% presented a normal BMI and 10% had an insufficient BMI. All patients gained weight during the monitoring with an overweight at 18 months for three patients. Along the overall monitoring, 44% of the patients had hormonal disruptions. The 3 patients with long-term overweight had frontal-temporal brain lesions. All three recovered walking. Only one had hormonal disruptions. Albuminaemia was normal for all patients who accepted to make this bioessay control.ConclusionThere is a tendency to gain weight after a severe TBI. Favorable factors include fronto-temporal injuries, and the presence of executive disorders. Endocrine perturbation and immobility can also contribute to overweight but were less frequently observed in this cohort

Genome-wide association analysis for heat tolerance at flowering detected a large set of genes involved in adaptation to thermal and other stresses

Fertilization sensitivity to heat in rice is a major issue within climate change scenarios in the tropics. A panel of 167 indica landraces and improved varieties was phenotyped for spikelet sterility (SPKST) under 38°C during anthesis and for several secondary traits potentially affecting panicle micro-climate and thus the fertilization process. The panel was genotyped with an average density of one marker per 29 kb using genotyping by sequencing. Genome-wide association analyses (GWAS) were conducted using three methods based on single marker regression, haplotype regression and simultaneous fitting of all markers, respectively. Fourteen loci significantly associated with SPKST under at least two GWAS methods were detected. A large number of associations was also detected for the secondary traits. Analysis of co-localization of SPKST associated loci with QTLs detected in progenies of bi-parental crosses reported in the literature allowed to narrow -down the position of eight of those QTLs, including the most documented one, qHTSF4.1. Gene families underlying loci associated with SPKST corresponded to functions ranging from sensing abiotic stresses and regulating plant response, such as wall-associated kinases and heat shock proteins, to cell division and gametophyte development. Analysis of diversity at the vicinity of loci associated with SPKST within the rice three thousand genomes, revealed widespread distribution of the favourable alleles across O. sativa genetic groups. However, few accessions assembled the favourable alleles at all loci. Effective donors included the heat tolerant variety N22 and some Indian and Taiwanese varieties. These results provide a basis for breeding for heat tolerance during anthesis and for functional validation of major loci governing this trait. (Résumé d'auteur

No inherent left and right side in human ‘mental number line': evidence from right brain damage

Spatial reasoning has a relevant role in mathematics and helps daily computational activities. It is widely assumed that in cultures with left-to-right reading, numbers are organized along the mental equivalent of a ruler, the mental number line, with small magnitudes located to the left of larger ones. Patients with right brain damage can disregard smaller numbers while mentally setting the midpoint of number intervals. This has been interpreted as a sign of spatial neglect for numbers on the left side of the mental number line and taken as a strong argument for the intrinsic left-to-right organization of the mental number line. Here, we put forward the understanding of this cognitive disability by discovering that patients with right brain damage disregard smaller numbers both when these are mapped on the left side of the mental number line and on the right side of an imagined clock face. This shows that the right hemisphere supports the representation of small numerical magnitudes independently from their mapping on the left or the right side of a spatial-mental layout. In addition, the study of the anatomical correlates through voxel-based lesion-symptom mapping and the mapping of lesion peaks on the diffusion tensor imaging-based reconstruction of white matter pathways showed that the rightward bias in the imagined clock-face was correlated with lesions of high-level middle temporal visual areas that code stimuli in object-centred spatial coordinates, i.e. stimuli that, like a clock face, have an inherent left and right side. In contrast, bias towards higher numbers on the mental number line was linked to white matter damage in the frontal component of the parietal-frontal number network. These anatomical findings show that the human brain does not represent the mental number line as an object with an inherent left and right side. We conclude that the bias towards higher numbers in the mental bisection of number intervals does not depend on left side spatial, imagery or object-centred neglect and that it rather depends on disruption of an abstract non-spatial representation of small numerical magnitude

The motor function measure to study limitation of activity in children and adults with Charcot-Marie-Tooth disease

AbstractObjectiveTo study the applicability and responsiveness of the motor function measure (total score and sub-scores D1, D2 and D3) in patients with Charcot-Marie-Tooth disease.Patients and methodsTwo hundred and thirty-three patients aged 4–86 years were included in the descriptive study. Scores and sub-scores were analyzed by age and by disease subtypes. Sensitivity to change (responsiveness) was estimated in patients having had at least two evaluations with at least six months between the first and the second.ResultsMotor function measure scores decrease with age, especially sub-scores D1 and D3. There were no significant differences between the scores according to type of Charcot-Marie-Tooth disease. The scores were significantly higher for ambulatory than for non-ambulatory patients. Significant responsiveness was demonstrated only in type 2 Charcot-Marie-Tooth disease.Discussion/conclusionsOur results suggest that, especially for D1 and D3 sub-scores, the motor function measure is a reliable and valid outcome measure that can be usefully applied in longitudinal follow-up. Studies of longer duration could demonstrate its responsiveness in other Charcot-Marie-Tooth disease subtypes

Impact of clinical pharmacy on the psychotropic drugs prescription in neurological rehabilitation: A retrospective study

IntroductionPsychotropic drugs are frequently prescribed in neuro-rehabilitation. In our institution, they account for 18% of prescriptions. For several years, clinical pharmacy activities were developed in collaboration with physicians and psychiatrists. The aim of this study is to evaluate the impact of this approach by the retrospective measure of psychotropic drugs consumption over 4 years, and link them to the evolution of hospital stays recorded through the PMSI (Programme de médicalisation des systèmes d’information, France).MethodsThe study took place over the period 2010–2013. It included three steps: 1/Monitoring of psychotropic drugs consumption (antipsychotics, anxiolytics, hypnotics and antidepressants) of 9 units (225 beds), by value and treatment days calculated from the daily average dosage (THERIAQUE); 2/Identification of hospitalised patients with at least one diagnosis code of either depression, anxiety, insomnia, and/or psychotic disorders; 3/Analysis of patient data with regard to drug consumption.ResultsFrom 2010 to 2013, the cost of psychotropic drugs was reduced by 24%, from 17,617 to 13,366 euros. The number of treatment days decreased by 30% from 84,765 to 59,466 days. The most significant decline was for hypnotic drugs (–62%) (28,110 to 10,623 days), and anxiolytic drugs (–37%) (28,958 to 18,343 days). The usage of antidepressant drugs increased by 21% (19,996 to 24,154 days), while the usage of antipsychotic drugs was stable (6346 days in 2013). During the same period, the overall number of patients with psychological diagnosis code hospital stays increased by 146% (213 to 523). It can be further detailed as follows: +380% for patients with an anxiety disorder (60 to 287), +71% for patients with depressive symptoms (78 to 133). Stays of patients with psychotic disorders remained stable.DiscussionThis study illustrates that a clinical pharmacy action targeted on psychotropic drugs prescriptions in collaboration with physicians and psychiatrists has reduced their consumption in neuro-rehabilitation. This decrease concerns mainly anxiolytic drugs and hypnotic drugs, despite the rise in number of hospital stays of patients with anxiety disorders. These results follow the recent recommendations of the ANSM (Agence nationale de sécurité du médicament, France)