Y a-t-il une place pour les interfaces cerveaux-machines dans l'évaluation de patients non-répondant ?

International audienceBrain computer interfaces (BCI) are often presented as a solution to restore communication for patients in cognitive motor dissociation. We review here the current state of the art, we compare BCI with current active EEG paradigms and discuss some translational limits and ethical risks

Les doubles cursus médecine-sciences en France

Les doubles cursus médecine-sciences (DC/MS) permettent l’acquisition d’une formation à la recherche et d’un doctorat de sciences au cours des études médicales. En France, avant les années 2000, la formation à la recherche était réalisée durant, voire après, le troisième cycle des études médicales (internat). Des DC/MS intégrés, dits « précoces », ont été développés depuis 2003 à l’initiative du cursus national de l’École de l’Inserm Liliane Bettencourt, suivie par la création de DC/MS par diverses universités. Quel que soit le mode de réalisation du double cursus, les étudiants engagés dans ces voies d’excellence se heurtent à des difficultés qui résultent essentiellement du manque d’articulation entre les formations médicale et scientifique. Les objectifs de ce texte sont de présenter les filières DC/MS de France, de recenser les principales difficultés rencontrées par les étudiants, ainsi que de formaliser un ensemble de propositions d’aménagements pour faciliter et consolider la formation des médecins/chercheurs

Feasibility and Acceptability of the 'HABIT' Group Programme for Comorbid Bipolar and Alcohol and Substance Use Disorders

OBJECTIVES: We investigated the feasibility and acceptability of an integrated group therapy (called HABIT) for comorbid bipolar disorder (BD) and alcohol and substance use disorders (ASUD) (BD-ASUD), a disabling clinical presentation for which no specific treatment has been validated. The 14-session HABIT programme employs psychoeducation-oriented cognitive-behaviour therapy (CBT) followed by mindfulness-based relapse prevention (MBRP) therapy. METHOD: Potential group participants were recruited from adult clients with a DSM-IV diagnosis of BD and an ASUD who were referred by their treating clinician. Observer-rated changes in mood symptoms and ASUD, attendance rates and subjective feedback are reported. RESULTS: Eight of 12 clients referred to the programme initially agreed to join the group, six attended the first group session and five clients completed the programme. Group mean scores for mood symptoms improved over time, with slightly greater reductions in depression during the first module. About 50% of individuals showed clinically significant improvement (≥q30% reduction) in alcohol and substance use. Attendance rates showed some variability between individuals and across sessions, but the average attendance rate of the group was marginally higher for the first module (86%) as compared with the second module (77%). Most clients reported high levels of general satisfaction with a group specifically targeted at individuals with BD-ASUD. CONCLUSION: This small pilot study suggests our intensive group therapy is acceptable and feasible. If findings are replicated, we may have identified a therapy that, for the first time, leads to improvement in both mood and substance use outcomes in clients with difficult-to-treat comorbid BD-ASUD. Copyright \textcopyright 2016 John Wiley & Sons, Ltd. Key Practitioner Message Comorbidity between bipolar and alcohol and substance use disorders (BD-ASUD) is frequent and highly disabling; Therapeutic research on approaches that can simultaneously help BD and ASUD is lacking; Previous research highlights the need for integrated treatment of both conditions but showed improvements limited to either element of the comorbid disorder; This pilot study supports the feasibility and acceptability of an intensive, 14-session group therapy programme that integrates CBT and mindfulness approaches

Retrospective study of the acute period of locked-in syndrome: Consciousness recovery and communication restoration

International audienceObjectiveBrainstem lesions can cause a locked-in syndrome (LIS). At the initial state, the LIS can be complete (CLIS), without any possibility for the patient to communicate. The main issues are to do the right diagnosis and the recovery of a communication. The delay to the diagnosis of LIS is of about 78 days after the initial injury (León-Carrión, 2002). The aim of this study is to identify possibilities to improve the care of persons with LIS at the initial state.Material/patients and methodsAn original questionnaire of 33 items, concerning patient's feelings and communication possibilities at the initial state of LIS, was sent to the 274 LIS members of the French association of LIS (ALIS) in November, 2015.ResultsForty LIS answered to the questionnaire (between 24 and 76 y.o., 25 men, LIS happened between 1990 and 2015). Seventy-eight percent of participants evoked a comatose state after the LIS, around 22 days on average, and 68% remember a period in CLIS, from 4 days to 6 months. This CLIS period was due to a total absence of voluntary movements in 60% of cases. Relatives used a lot the “yes-no” code for 85% of the participants, but the score decreased to 28% for the doctors. Movements considered as very reliable were the blinks (for 61.1% of the participants), eyes movements (42%), and heads ones (25%). Augmentative and alternative communication tools recommended by the participants for the initial phase are “low cost” tools (81.8% thought they are essential), computers and internet connections (53%). Participants wished people talked to them in priority about news from their relatives (82.5% wished that a lot) and psychological suffering (57.5%). Finally, the diagnosis announcement often remains indirect, in 40% of the cases.Discussion - conclusionCommunication recovery at the initial state of the LIS is often retardated. The “yes-no” code instauration could happen earlier, as the use of “low cost” communication devices

The challenge of controlling an auditory BCI in the case of severe motor disability

International audienceAbstract Background The locked-in syndrome (LIS), due to a lesion in the pons, impedes communication. This situation can also be met after some severe brain injury or in advanced Amyotrophic Lateral Sclerosis (ALS). In the most severe condition, the persons cannot communicate at all because of a complete oculomotor paralysis (Complete LIS or CLIS). This even prevents the detection of consciousness. Some studies suggest that auditory brain–computer interface (BCI) could restore a communication through a « yes–no» code. Methods We developed an auditory EEG-based interface which makes use of voluntary modulations of attention, to restore a yes–no communication code in non-responding persons. This binary BCI uses repeated speech sounds (alternating “yes” on the right ear and “no” on the left ear) corresponding to either frequent (short) or rare (long) stimuli. Users are instructed to pay attention to the relevant stimuli only. We tested this BCI with 18 healthy subjects, and 7 people with severe motor disability (3 “classical” persons with locked-in syndrome and 4 persons with ALS). Results We report online BCI performance and offline event-related potential analysis. On average in healthy subjects, online BCI accuracy reached 86% based on 50 questions. Only one out of 18 subjects could not perform above chance level. Ten subjects had an accuracy above 90%. However, most patients could not produce online performance above chance level, except for two people with ALS who obtained 100% accuracy. We report individual event-related potentials and their modulation by attention. In addition to the classical P3b, we observed a signature of sustained attention on responses to frequent sounds, but in healthy subjects and patients with good BCI control only. Conclusions Auditory BCI can be very well controlled by healthy subjects, but it is not a guarantee that it can be readily used by the target population of persons in LIS or CLIS. A conclusion that is supported by a few previous findings in BCI and should now trigger research to assess the reasons of such a gap in order to propose new and efficient solutions. Clinical trial registrations : No. NCT02567201 (2015) and NCT03233282 (2013)