Commentary: Integrating electrodermal biofeedback into pharmacologic treatment of grand mal seizures

Thirty percent of patients with epilepsy experience seizures despite optimal anticonvulsant drug treatment. Stress is frequently identified by patients with epilepsy as a precipitant of seizures (Spector et al., 2000; Ferlisi and Shorvon, 2014). Patients also often report using countermeasures to control the seizure onset. These are typically spontaneous and individualized such as increasing arousal by walking, breathing, standing, focusing attention, changing way of thinking, and more rarely inducing relaxation (Lee and No, 2005; Hether et al., 2013). In parallel, behavioral and psychological interventions, complementing conventional therapeutic methods for the management of epileptic seizures, have gained greater clinical attention over the past decade. Among these, Biofeedback (BFK) represents a noninvasive biobehavioral treatment that enables a patient to gain volitional control over a specific physiological process. BFK has already shown its value when applied to patients with epilepsy (Sterman and Friar, 1972; Rockstroh et al., 1993; Nagai et al., 2004a; Nagai, 2011; Micoulaud-Franchi et al., 2014a,b). Scrimali et al. (2015) have rightly pointed out the potential usefulness of electrodermal biofeedback in the management of refractory epilepsy. In a single case study, they report an effect of electrodermal activity (EDA) relaxation biofeedback in reducing seizures in a patient treated for 2 years. This case study supports the necessity to expand clinical armamentarium for treatment-resistant patients with few alternatives

Investigating associations between social determinants, self-efficacy measurement of sleep apnea and CPAP adherence: the SEMSA study

Study objectivesThe prospective Self-Efficacy Measure for Sleep Apnea study (SEMSAS) is investigating thresholds for health literacy, self-efficacy and precariousness at obstructive sleep apnea (OSA) diagnosis to predict CPAP adherence. This paper describes the study protocol and presents baseline data from the ongoing study.MethodsEligible individuals had confirmed OSA and were referred to a homecare provider for continuous positive airway pressure (CPAP) therapy initiation. Data on patient characteristics and comorbidities were collected, along with baseline evaluations of self-efficacy [15-item Self-Efficacy Measure for Sleep Apnea tool (SEMSA-15)], precariousness [Deprivation in Primary Care Questionnaire (DipCareQ)], and health literacy (Health Literacy Questionnaire). CPAP adherence over 12 months of follow-up will be determined using remote monitoring of CPAP device data. The primary objective is to define an optimal SEMSA-15 score threshold to predict CPAP adherence at 3- and 12-month follow-up.ResultsEnrollment of 302 participants (71% male, median age 55 years, median body mass index 31.6 kg/m2) is complete. Low self-efficacy (SEMSA-15 score ≤ 2.78) was found in 93/302 participants (31%), and 38 (12.6%) reported precariousness (DipCareQ score > 1); precariousness did not differ significantly between individuals with a SEMSA-15 score ≤ 2.78 versus >2.78. Health literacy was generally good, but was significantly lower in individuals with versus without precariousness, and with low versus high self-efficacy.ConclusionSEMSAS is the first study using multidimensional baseline assessment of self-efficacy, health literacy and precariousness, plus other characteristics, to determine future adherence to CPAP, including CPAP adherence trajectories. Collection of follow-up data is underway

J Clin Sleep Med

Non-24-hour sleep-wake disorder is 1 of several chronic circadian rhythm sleep-wake disorders. It is defined as progressive daily shifts in sleep onset and wake times. It mainly affects patients who are sight-impaired, is relatively rare in sighted patients, and is difficult to treat, with no guidelines. This case report discusses non-24-hour sleep-wake disorder in a sighted young man who complained of alternating severe insomnia and excessive sleepiness, with a sleep agenda and actigraphic data showing a daily delay of approximately 2 hours. A novel therapy by total sleep deprivation followed by a combination of morning light therapy and nocturnal melatonin administration was efficient in stopping his free-running sleep-wake pattern both immediately and in the long term. The treatment combination for 6 months resulted in stable circadian entrainment to a 24-hour cycle. Compliance with chronotherapy was maintained over the course of follow-up

Psychiatric and psychological follow-up of undergraduate and postgraduate medical students: prevalence and associated factors. Results from the national BOURBON study. Running title: mental health and addictive behavior of medical students

International audienceBackgroundPhysicians are at risk of burnout, anxiety and depression. Prevention is needed from the beginning of the medical studies to detect early poor mental health outcomes.ObjectiveTo determine the prevalence and associated of psychiatric or psychological follow-up in a national sample of undergraduate and postgraduate medical students (UPMS).MethodsUPMS of the 35 French Medicine faculties were recruited through mailing lists and social networks between December 2016 and May 2017 and fulfilled Internet anonymised questionnaires.ResultsOverall, 10,985 UPMS were included in the present study (2165 (19.7%) postgraduate, 31.6% males, mean aged 21.8 years). Overall, 1345 (12.2%) were followed-up by a psychiatrist and/or a psychologist, 20.5% of them were regular anxiolytic consumers and 17.2% of them were regular antidepressant consumers. In multivariate analyses, being followed-up by a psychiatrist and/or psychologist was associated with older age (aOR = 1.2[1.2–1.2], p < 0.0001), female gender (aOR = 0.5[0.5–0.7], p < 0.0001), current alcohol use disorder (aOR = 1.3[1.3–1.5], p < 0.0001), higher anxiolytic (aOR = 3.1[2.5–3.7],p < 0.0001) and antidepressant (aOR = 11.7[7.6–18.0],p < 0.0001) consumption, and with lower self-reported general health, social functioning and mental health quality of life (all aORs = 0.9, all p < 0.05). The UPMS followed-up by psychiatrist and/or psychologist reported to have been more frequently exposed to sexual assault (5.1% vs. 0.9%, aOR = 2.5[1.3–4.7], p < 0.0001), domestic violence (3.3% vs. 0.8% aOR = 2.1[1.2–4.0], p = 0.01) and parents divorce (11% vs. 6.4%, aOR = 1.5[1.2–1.9], p = 0.001). Students followed-up by a psychiatrist and/or psychologist reported more frequently to seek alleviating anxiety (aOR 1.9[1.6–2.3], p < 0.0001), depression (aOR 1.7[1.3–2.1],p < 0.0001), coping with studies difficulties (aOR 1.5[1.2–1.8],p < 0.0001), experiencing more stress at hospital (aOR = 2.3[1.6–3.5],p < 0.001) and more burnout syndrome (aOR = 1.4[1.1–1.8], p = 0.03).ConclusionsAround 12% of UPMS are followed-up by a psychiatrist and/or a psychologist. These students reported higher antidepressant and anxiolytic consumption, psychic suffering and altered quality of life, associated with professional pressure and personal issues. Public health programs should be developed to help these students through their studies to prevent later mental /addictive issues and professional suffering. Improving UPMS mental health may also improve the later quality of care of their patients and global stress at hospital

Quality of life is associated with chronic inflammation in schizophrenia: a cross-sectional study

International audienceInflammation may play a crucial role in the pathogenesis of schizophrenia. However, the association between chronic inflammation and health outcomes in schizophrenia remains unclear, particularly for patient-reported outcomes. The aim of this study was to investigate the relationship between quality of life (QoL) and chronic inflammation assessed using C -Reactive Protein (CRP) in patients with schizophrenia. Two hundred and fifty six patients with schizophrenia were enrolled in this study. After adjusting for key socio-demographic and clinical confounding factors, patients with high levels of CRP (>3.0 mg/l) had a lower QoL than patients with normal CRP levels (OR = 0.97, 95% CI = 0.94-0.99). An investigation of the dimensions of QoL revealed that psychological well-being, physical well-being and sentimental life were the most salient features of QoL associated with CRP. Significant associations were found between lower educational level (OR = 4.15, 95% CI = 1.55-11.07), higher body mass index (OR = 1.16, 95% CI = 1.06-1.28), higher Fagerstrom score (OR = 1.22, 95% CI = 1.01-1.47) and high levels of CRP. After replications with longitudinal approaches, the association between QoL and chronic inflammation may offer interesting interventional prospects to act both on inflammation and QoL in patients with schizophrenia

L’horizon de la phénoménologie expérientielle : les formes incandescentes de la présence humaine

I) Introduction : la phénoménologie expérientielle Depuis la plus haute Antiquité, et dans plusieurs continents, les philosophes, les religieux, les sages, les mystiques mais aussi d’autres humains n’ayant que la prétention de moins mal comprendre ce qu’il en est de leur vie mentale, posent un regard réflexif sur le contenu et l’organisation de la vie de l’esprit. En Occident, une étape décisive fut franchie par Husserl, quand il prit le parti d’une analyse systématique et scientifique des vé..

Design and Preliminary Study of a Neurofeedback Protocol to reduce Drowsiness

International audienceNeuroFeedback (NF) consists in using electroencephalographic (EEG) measurements to guide users to perform a cognitive learning using information coming from their own brain activity, by means of a real-time sensory feedback (e.g., visual or auditory)[4]. Many NF approaches have been studied to improve attentional abilities, notably for Attention Deficit Hy-peractivity Disorder [1, 2]. However, to our knowledge, no NF solution has been proposed to specifically reduce drowsiness. Thus, we propose a complete EEG-NF solution to train users to self-regulate an EEG marker of drowsiness. This marker is based on a ratio of beta over theta/alpha power in Cz electrode. In addition to this EEG marker of drowsiness, we also carefully selected and designed the duration, the sequencing, the objective evaluation metrics and the visual and audio feedback to use in for each NF session. Preliminary study with five healthy subjects showed that three of them could learn to self-regulate this EEG marker with a relatively short number of NF sessions (up to 8 sessions of 40 min). Clinical trials with sleep-deprived subjects are expected to begin in 2019 to study possible cognitive and clinical benefits of this self-regulation. The implementation of this NF solution is available for free 1 , with the OpenViBE platform [3], under the AGPL-3.0 license

Conception et étude préliminaire d'un protocole de neurofeedback visant à autoréguler un marqueur EEG de la somnolence

International audienceNeurofeedback (NF) consists in using electroencephalographic (EEG) measurements to guide users to perform a cognitive learning using information coming from their own brain activity, by means of a real-time sensory feedback (e.g., visual or auditory). Many NF approaches have been studied to improve atten-tional abilities, notably for attention deficit hyper activity disorder. However, to our knowledge, no NF solution has been proposed to specifically reduce drowsiness. Thus, we propose an EEG-NF solution to train users to self-regulate an EEG marker of drowsiness, and evaluate it with a preliminary study. Results with five healthy subjects showed that three of them could learn to self-regulate this EEG marker with a relatively short number of NF sessions (up to 8 sessions of 40 min). Clinical trials with sleep-deprived subjects should begin in 2019 to study possible cognitive and clinical benefits of this self-regulation. This NF solution implementation is available for free, with the OpenViBE platform, under the AGPL-3.0 license.Le neurofeedback (NF) consiste à utiliser des mesures électroencéphalographiques (EEG) pour aider les utilisateurs à effectuer un apprentissage cognitif en utilisant des informations provenant de leur propre activité cérébrale, au moyen d'un retour sensoriel en temps réel (visuel ou auditif, par exemple). De nombreuses approches du NF ont été étudiées pour améliorer les capacités d'attention, notamment pour le trouble d'hyperactivité avec déficit de l'attention. Cependant, à notre connaissance, aucune solution de NF n'a été proposée pour réduire spécifiquement la somnolence. Ainsi, nous proposons une solution de NF-EEG pour former les utilisateurs à l’autorégulation d’un marqueur EEG de la somnolence et l’évaluer avec une étude préliminaire. Les résultats, avec cinq sujets sains, ont montré que trois d'entre eux pourraient apprendre à autoréguler ce marqueur EEG avec un nombre relativement court de séances de NF (jusqu'à 8 séances de 40 min). Les essais cliniques sur des sujets privés de sommeil devraient commencer en 2019 pour étudier les avantages cognitifs et cliniques possibles de cette autorégulation. Cette mise en œuvre de la solution de NF est disponible gratuitement, avec la plateforme OpenViBE, sous la licence AGPL-3.0

Non-REM Sleep Characteristics Predict Early Cognitive Impairment in an Aging Population

Objective: Recent research suggests that sleep disorders or changes in sleep stages or EEG waveform precede over time the onset of the clinical signs of pathological cognitive impairment (e.g., Alzheimer's disease). The aim of this study was to identify biomarkers based on EEG power values and spindle characteristics during sleep that occur in the early stages of mild cognitive impairment (MCI) in older adults.Methods: This study was a case-control cross-sectional study with 1-year follow-up of cases. Patients with isolated subjective cognitive complaints (SCC) or MCI were recruited in the Bordeaux Memory Clinic (MEMENTO cohort). Cognitively normal controls were recruited. All participants were recorded with two successive polysomnography 1 year apart. Delta, theta, and sigma absolute spectral power and spindle characteristics (frequency, density, and amplitude) were analyzed from purified EEG during NREM and REM sleep periods during the entire second night.Results: Twenty-nine patients (8 males, age = 71 ± 7 years) and 29 controls were recruited at T0. Logistic regression analyses demonstrated that age-related cognitive impairment were associated with a reduced delta power (odds ratio (OR) 0.072, P &lt; 0.05), theta power (OR 0.018, P &lt; 0.01), sigma power (OR 0.033, P &lt; 0.05), and spindle maximal amplitude (OR 0.002, P &lt; 0.05) during NREM sleep. Variables were adjusted on age, gender, body mass index, educational level, and medication use. Seventeen patients were evaluated at 1-year follow-up. Correlations showed that changes in self-reported sleep complaints, sleep consolidation, and spindle characteristics (spectral power, maximal amplitude, duration, and frequency) were associated with cognitive impairment (P &lt; 0.05).Conclusion: A reduction in slow-wave, theta and sigma activities, and a modification in spindle characteristics during NREM sleep are associated very early with a greater risk of the occurrence of cognitive impairment. Poor sleep consolidation, lower amplitude, and faster frequency of spindles may be early sleep biomarkers of worsening cognitive decline in older adults