Le syndrome des jambes sans repos (mise au point)

DIJON-BU Médecine Pharmacie (212312103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

La narcolepsie (physiopathologie et traitements en 2011)

DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Epidémiologie des accidents vasculaires cérébraux et des accidents ischémiques transitoires dans la ville de Dijon, France (Doctorat (Neurologie))

DIJON-BU Médecine Pharmacie (212312103) / SudocPARIS-BIUM (751062103) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Estimation temporelle et exploration du système limbique

International audienceIntroductionL’évaluation émotionnelle actuelle apprécie son aspect explicite et non ses mécanismes physiologiques. Basée sur le modèle d’horloge interne, l’estimation temporelle serait une mesure implicite d’activation émotionnelle.ObjectifsÀ partir du modèle de l’horloge interne, étudier l’influence de l’ amygdale et du cortex orbito-frontal sur la perturbation de l’estimation temporelle grâce à un amorçage par des stimulis émotionnels olfactifs et vidéos.MéthodesÉtude longitudinale, randomisée, ouverte, monocentrique, menée sur 50 sujets sains de 55 à 95 ans au CHU de Dijon. Les sujets étaient randomisés en groupe « stimuli olfactif » et « stimuli auditif ». Une tâche d’estimation temporelle sur 7 sons était réalisée puis réitérée après présentation des stimulis. La différence d’estimation temporelle pré- et post-stimuli et la réponse électrodermale (RED) étaient mesurées puis une corrélation était calculée séparément pour chacun des stimulis.RésultatsLes stimulis olfactifs ont entraîné une surestimation temporelle constante, indépendante du stimuls olfactif (F = 9,58, p < 0,01) et une augmentation de la réponse électrodermale. Pour les vidéos, l’estimation temporelle varie en fonction du nombre de stimulis présentés (sous estimation temporelle initiale à surestimation finale, F = 18,16, p < 0,01 ; contraste linéaire F = 72,77, p < 0,01). Pour les stimulis vidéos, il existe une corrélation négative entre l’amplitude de la RED et l’estimation temporelle (r = 0,81, p = 0,026).DiscussionSelon le modèle de Gibbon, la surestimation temporelle après stimuli émotionel olfactif correspond à une saturation de l’horloge interne amygdalienne (traitement implicite des émotions). La sous-estimation initiale lors des stimulis vidéos correspond au recrutement initial de facteurs attentionels au niveau frontal (traitement expicite). L’atténuation de la RED, corrélée à une surestimation temporelle traduit une régulation émotionelle.ConclusionLes résultats confirment que notre tâche d’amorçage affectif avec stimuli vidéo peut représenter un outil utile pour fournir une évaluation non-invasive de l’activation de l’amygdale et du système orbito-frontal

Reduced brain N-acetyl-aspartate in frontal lobes suggests neuronal loss in patients with amyotrophic lateral sclerosis

International audienceAbstract: We performed proton magnetic resonance spectroscopy (IH-MRS) in three patients with amyotrophic lateral sclerosis (ALS) to evaluate the distribution and extent of cortical neuronal damage as demonstrated by decreased N-acetyl-aspartate (NAA) levels. We examined primary motor (precentral gyrus) and parietal neocortical (superior parietal gyrus) regions. ALS was defined with lower and upper motor neuron signs. Compared with matched healthy controls, ALS patients had a significant decrease in NAA levels in the primary motor cortex (p<0.001) compared with parietal regions and homologous regions in healthy controls. Two clinical applications can be extracted: first, the upper motor neuron signs present in the ALS, come from a neuronal loss within the primary motor cortex and may explain the frontal syndrome associated with ALS. Second clinical applications of 1H-MRS could include identification of extent of upper motor neuron involvement, aiding diagnosis of syndromes presenting with an ALS-like syndrome

Évaluation du jugement temporel après l'introduction d'un stimulus émotionnel de nature olfactive : apport dans le diagnostic différentiel entre la maladie d'Alzheimer et les troubles de l'humeur

Revue non indexée dans le JCR.La multiplicité des termes et des théories concernant les émotions rend leur évaluation particulièrement complexe. La majorité des évaluations actuelles ne prend en compte que l’expérience psychique de l’individu et omet la part implicite des processus émotionnels. Les procédures d’amorçage permettent d’étudier ce type de traitement inconscient. En nous appuyant sur les paradigmes d’amorçage affectif et les modèles d’horloge interne, nous avons élaboré un paradigme d’amorçage émotionnel. Il consiste en une tâche de jugement temporel après l’introduction d’un stimulus émotionnel. En temps normal, l’introduction d’un tel stimulus va créer une activation de l’horloge interne par les réactions physiologiques qui l’accompagnent et générer une surestimation temporelle. Dans le cas d’une atteinte frontale et en absence d’un système d’anticipation et de régulation émotionnelle, un syndrome d’hypofonctionnement limbique est attendu. Il se traduit dans le test d’amorçage émotionnel par une surestimation temporelle moins importante que la normale. À l’inverse une atteinte temporale se caractérise par un effet d’amorçage plus important et une surestimation temporelle. Il correspondrait à un syndrome d’hyperfonctionnement limbique. L’intérêt de ce paradigme a été étudié dans le diagnostic différentiel entre la maladie d’Alzheimer et les troubles de l’humeur où l’on attend un dysfonctionnement limbique inverse du fait des régions atteintes. Cet article a pour but de présenter cette première recherche effectuée et donc un premier apport d’un test évaluant le traitement émotionnel implicite. L’objectif final est de pouvoir ensuite généraliser l’utilisation de ce test à l’observation d’autres pathologies afin de mieux comprendre les troubles émotionnels et les répercussions comportementales qui les composent

N-ACETYL-ASPARTATE ABNORMALITIES IN INTERNAL-TEMPORAL EPILEPTICUS FOCUS USING PROTON MAGNETIC-RESONANCE SPECTROSCOPY

International audienceAbstract: The aim of this study was to characterize the neurochemical abnormalities related to N-acetyl-aspartate which is a neuronal marker, within an epilepticus focus located in the internal-temporal area, using proton magnetic resonance spectroscopy, Eleven patients,with a mono-hippocampal epilepticus focus on clinical and per-critical electroencephalographical criteria, were matched with II controls by age, sex and laterality. Proton spectroscopy of a volume of 8 cm(3) was performed within the ipsilateral and the contralateral internal-temporal area and within the 2 hippocampus of controls. Volumetry of the ipsilateral and the contralateral hippocampus and of the 2 hippocampus of controls was performed using resonance magnetic imaging All these measurements were performed during the interictal stage. The results were concordant to show a decrease of the ratio N-acetyl-aspartate/choline and N-acetyl-aspartate/creatine within the epilepticus focus, in relation with a hippocampal atrophy. This study finds similar results to those of other previous works. The decrease of N-acetyl-aspartate levels within the epilepticus focus could be related to a decrease of the neuronal cell density. This procedure is able to show a decrease of the levels of this metabolite within an internal temporal epilepticus focus and associated with a hippocampal atrophy

Psychiatric Presentation of Frontotemporal Dementia Associated with Inclusion Body Myopathy due to the VCP Mutation (R155H) in a French Family

Introduction: Inclusion body myopathy with Paget's disease of the bone and frontotemporal dementia (IBMPFD) is a rare late-onset autosomal dominant disorder due to a mutation of the valosin-containing protein (VCP) gene. Case Report: We report the case of a patient who developed progressive weakness of the limbs in his fifties, until he was confined to a wheelchair. At that time, he developed acute behavioural changes including irritability, severe anxiety and major depression, which led to him being hospitalised in a psychiatric hospital. He also suffered from aphasia and executive function impairment, which helped us to diagnose a behavioural form of frontotemporal dementia (FTD). The diagnosis of IBMPFD due to a mutation in the VCP gene was confirmed by a genetic study of the VCP gene (R155H mutation). Discussion: The clinical diagnosis of IBMPFD is suggested by the presence of at least one of three major manifestations as follows: inclusion body myopathy (mean onset at 42 years of age), Paget's disease of the bone and FTD (mean onset at 55 years of age). It is mostly the behavioural form of FTD (behavioural changes, executive dysfunction and aphasia). One interesting finding in our report is the predominance of the psychiatric symptoms at the beginning of the behavioural changes, which led to the diagnosis of FTD. The diagnosis of IBMPFD was confirmed by the genetic study: the R155H mutation found on exon 5 domain CDC48 is the most frequent of the 18 known mutations in the VCP gene

Multi-variate analysis predicts clinical outcome 30 days after middle cerebral artery infarction.

International audienceBACKGROUND AND PURPOSE: To evaluate the functional prognostic value of proton magnetic resonance spectroscopy performed within the 5 days of an infarction of the middle cerebral artery territory, compared with previously demonstrated prognostic factors. METHODS: Proton magnetic resonance spectroscopy was performed on 77 consecutive non-comatosed patients during the acute stage of middle cerebral artery infarction. The functional status was determined for each patient via the Orgogozo score. Proton magnetic resonance spectroscopic data were acquired in the infarction and in contra-lateral normal tissue and the results were expressed as metabolite ratios. Correlations were evaluated between the Orgogozo score at day 1 and day 30, the age, the sex, the volume of the infarction, and the metabolic ratios. RESULTS: In a monovariate analysis, the decrease of the NAA/choline ratio was correlated with a low Orgogozo score at days 1 and 30 (P<0.05) and with a large infarction (P<0.05). A stepwise analysis showed a significant relationship between the Orgogozo score at day 30 and the Orgogozo score at day 1, the sex, the volume of infarction, and the NAA/Cho ratio within the infarction. CONCLUSIONS: Our work demonstrates that a good clinical outcome at day 30 depends on a good initial clinical score at day 1, a small volume of infarction, a small decrease of NAA/Cho, and being of the female gender

Adherence to mental health care and caregiver-patient relationship after diagnosis of psychogenic non-epileptic seizures: Longitudinal follow-up study

International audiencePurpose: This study aimed to describe the quality of adherence to mental health care follow-up and the mental health caregiver-patient relationship after diagnosis of psychogenic non-epileptic seizures (PNES).Methods: We conducted an ancillary study of a multicenter prospective study. Patients (n = 108) received a standardized diagnostic explanation of PNES following video-EEG. They were referred to their community mental health centers or to a private psychiatrist/psychologist, who received written information about PNES and the study. Data collected about adherence to care (follow-up started or not, consensual and those who withdrew non-consensually, ongoing follow-up) were cross-tabulated from patients and care structures by telephone at 6, 12, 18 and 24 months after diagnosis. At M24, we collected reasons for stopping follow-up by phone using a predefined 9-item questionnaire. We also assessed the perception of the caregiver-patient relationship among patients who started follow-up and their mental health caregivers with a simple questionnaire based on five dimensions: feeling comfortable, continuity of care, content of therapy sessions, effectiveness of therapy sessions, and the patient's overall assessment of the follow-up.Results: From M6 to M24, ongoing follow-up decreased from 64.8 to 25.8%, while the "not following initial recommandations" group of patients (those who never started follow-up and those who withdrew non-consensually) increased from 35.2 to 64.9%. We found two main reasons for stopping follow-up: lack of interest and feeling better. Adherent patients had an overall more positive view of their therapy than caregivers.Conclusion: Only a third of PNES patients adhered to a mental health care program and felt comfortable in the caregiver-patient relationship. Solutions need to be found to help patients understand the interest of follow-up therapy and help mental health caregivers improve their feeling of competence