1
|
Gardette J, Mosca C, Asien C, Borg C, Mazzola L, Convers P, Gal G, Banjac S, Baciu M, Durocher B, Kahane P, Hot P. Complex visual discrimination is impaired after right, but not left, anterior temporal lobectomy. Hippocampus 2023; 33:1113-1122. [PMID: 37483092 DOI: 10.1002/hipo.23569] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 05/24/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Abstract
The prevailing view in human cognitive neuroscience associates the medial temporal lobes (MTLs) with declarative memory. Compelling experimental evidence has, however, demonstrated that these regions are specialized according to the representations processed, irrespective of the cognitive domain assessed. This account was supported by the study of patients with bilateral medial temporal amnesia, who exhibit impairments in perceptual tasks involving complex visual stimuli. Yet, little is known regarding the impact of unilateral MTL damage on complex visual abilities. To address this issue, we administered a visual matching task to 20 patients who underwent left (N = 12) or right (N = 8) anterior temporal lobectomy for drug-resistant epilepsy and to 38 healthy controls. Presentation viewpoint was manipulated to increase feature ambiguity, as this is critical to reveal impairments in perceptual tasks. Similar to control participants, patients with left-sided damage succeeded in all task conditions. In contrast, patients with right-sided damage had decreased accuracy compared with that of the other two groups, as well as increased response time. Notably, the accuracy of those with right-sided damage did not exceed chance level when feature ambiguity was high (i.e., when stimuli were presented from different viewpoints) for the most complex classes of stimuli (i.e., scenes and buildings, compared with single objects). The pattern reported in bilateral patients in previous studies was therefore reproduced in patients with right, but not left, resection. These results suggest that the complex visual-representation functions supported by the MTL are right-lateralized, and raise the question as to how the representational account of these regions applies to representations supported by left MTL regions.
Collapse
Affiliation(s)
- Jeremy Gardette
- LPNC, CNRS, UMR 5105, Université Grenoble Alpes, Université Savoie Mont Blanc, Grenoble, France
| | - Chrystèle Mosca
- Neurology Department, Chu Grenoble-Alpes, Univ. Grenoble Alpes, Grenoble Institut Neuroscience, Inserm U1216, Grenoble, France
| | - Cassandra Asien
- LPNC, CNRS, UMR 5105, Université Grenoble Alpes, Université Savoie Mont Blanc, Grenoble, France
- Neurology Department, Chu Grenoble-Alpes, Univ. Grenoble Alpes, Grenoble Institut Neuroscience, Inserm U1216, Grenoble, France
| | - Céline Borg
- Neurology Department, University Hospital, Saint-Etienne, France
| | - Laure Mazzola
- Neurology Department, University Hospital, Saint-Etienne, France
| | - Philippe Convers
- Neurology Department, University Hospital, Saint-Etienne, France
| | - Guillaume Gal
- Neurology Department, University Hospital, Saint-Etienne, France
| | - Sonja Banjac
- LPNC, CNRS, UMR 5105, Université Grenoble Alpes, Université Savoie Mont Blanc, Grenoble, France
| | - Monica Baciu
- LPNC, CNRS, UMR 5105, Université Grenoble Alpes, Université Savoie Mont Blanc, Grenoble, France
| | - Bastien Durocher
- LPNC, CNRS, UMR 5105, Université Grenoble Alpes, Université Savoie Mont Blanc, Grenoble, France
| | - Philippe Kahane
- Neurology Department, Chu Grenoble-Alpes, Univ. Grenoble Alpes, Grenoble Institut Neuroscience, Inserm U1216, Grenoble, France
| | - Pascal Hot
- LPNC, CNRS, UMR 5105, Université Grenoble Alpes, Université Savoie Mont Blanc, Grenoble, France
- Institut Universitaire de France, Paris, France
| |
Collapse
|
2
|
Demarquay G, Sala E, Adham A, Camdessanché JP, Convers P, Mazzola L. Frontal headache in a patient with right temporal epilepsy: A video-EEG case report of ictal epileptic headache. Headache 2023; 63:455-458. [PMID: 36905157 DOI: 10.1111/head.14475] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 03/12/2023]
Abstract
BACKGROUND Ictal epileptic headache (IEH) is caused by a focal epileptic seizure. The diagnosis can be challenging when the headache is isolated without any other symptoms. CASE REPORT A 16-year-old girl presented with a 5-year history of bilateral frontotemporal headaches with severe intensity lasting for 1-3 min. Past medical, physical, and developmental histories were unremarkable. Head magnetic resonance imaging showed right hippocampal sclerosis. The diagnosis of pure IEH was confirmed by video-electroencephalographic monitoring. The onset and cessation of frontal headache correlated with a right temporal discharge. The patient was diagnosed with right mesial temporal lobe epilepsy. Two years later, her seizures increased despite antiseizure medications. A right anterior temporal lobectomy was performed. The patient remained seizure-free and headache-free for 10 years. CONCLUSION IEH should be considered in the differential diagnosis of brief and isolated headache, even if the headache is diffuse or contralateral to the epileptogenic focus.
Collapse
Affiliation(s)
- Geneviève Demarquay
- Department of Neurology, Hospices Civils de Lyon, University of Lyon, Lyon, France
- NeuroPain Lab, INSERM U1028, UMR5292, Lyon Neuroscience Research Center, CNRS, University Claude Bernard Lyon 1, Lyon, France
| | - Emilie Sala
- Pain Unit, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Ahmed Adham
- Department of Neurology, University Hospital, Saint-Etienne, France
| | | | - Philippe Convers
- NeuroPain Lab, INSERM U1028, UMR5292, Lyon Neuroscience Research Center, CNRS, University Claude Bernard Lyon 1, Lyon, France
- Department of Neurology, University Hospital, Saint-Etienne, France
| | - Laure Mazzola
- NeuroPain Lab, INSERM U1028, UMR5292, Lyon Neuroscience Research Center, CNRS, University Claude Bernard Lyon 1, Lyon, France
- Department of Neurology, University Hospital, Saint-Etienne, France
| |
Collapse
|
3
|
Parenti I, Leitão E, Kuechler A, Villard L, Goizet C, Courdier C, Bayat A, Rossi A, Julia S, Bruel AL, Tran Mau-Them F, Nambot S, Lehalle D, Willems M, Lespinasse J, Ghoumid J, Caumes R, Smol T, El Chehadeh S, Schaefer E, Abi-Warde MT, Keren B, Afenjar A, Tabet AC, Levy J, Maruani A, Aledo-Serrano Á, Garming W, Milleret-Pignot C, Chassevent A, Koopmans M, Verbeek NE, Person R, Belles R, Bellus G, Salbert BA, Kaiser FJ, Mazzola L, Convers P, Perrin L, Piton A, Wiegand G, Accogli A, Brancati F, Benfenati F, Chatron N, Lewis-Smith D, Thomas RH, Zara F, Striano P, Lesca G, Depienne C. The different clinical facets of SYN1-related neurodevelopmental disorders. Front Cell Dev Biol 2022; 10:1019715. [PMID: 36568968 PMCID: PMC9773998 DOI: 10.3389/fcell.2022.1019715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/20/2022] [Indexed: 12/13/2022] Open
Abstract
Synapsin-I (SYN1) is a presynaptic phosphoprotein crucial for synaptogenesis and synaptic plasticity. Pathogenic SYN1 variants are associated with variable X-linked neurodevelopmental disorders mainly affecting males. In this study, we expand on the clinical and molecular spectrum of the SYN1-related neurodevelopmental disorders by describing 31 novel individuals harboring 22 different SYN1 variants. We analyzed newly identified as well as previously reported individuals in order to define the frequency of key features associated with these disorders. Specifically, behavioral disturbances such as autism spectrum disorder or attention deficit hyperactivity disorder are observed in 91% of the individuals, epilepsy in 82%, intellectual disability in 77%, and developmental delay in 70%. Seizure types mainly include tonic-clonic or focal seizures with impaired awareness. The presence of reflex seizures is one of the most representative clinical manifestations related to SYN1. In more than half of the cases, seizures are triggered by contact with water, but other triggers are also frequently reported, including rubbing with a towel, fever, toothbrushing, fingernail clipping, falling asleep, and watching others showering or bathing. We additionally describe hyperpnea, emotion, lighting, using a stroboscope, digestive troubles, and defecation as possible triggers in individuals with SYN1 variants. The molecular spectrum of SYN1 variants is broad and encompasses truncating variants (frameshift, nonsense, splicing and start-loss variants) as well as non-truncating variants (missense substitutions and in-frame duplications). Genotype-phenotype correlation revealed that epileptic phenotypes are enriched in individuals with truncating variants. Furthermore, we could show for the first time that individuals with early seizures onset tend to present with severe-to-profound intellectual disability, hence highlighting the existence of an association between early seizure onset and more severe impairment of cognitive functions. Altogether, we present a detailed clinical description of the largest series of individuals with SYN1 variants reported so far and provide the first genotype-phenotype correlations for this gene. A timely molecular diagnosis and genetic counseling are cardinal for appropriate patient management and treatment.
Collapse
Affiliation(s)
- Ilaria Parenti
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Elsa Leitão
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Alma Kuechler
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Laurent Villard
- INSERM, MMG, Faculté de Médecine, Aix-Marseille University, Marseille, France,Département de Génétique Médicale, APHM, Hôpital d'Enfants de La Timone, Marseille, France
| | - Cyril Goizet
- Service de Génétique Médicale, Bordeaux, France,Centre de Référence Maladies Rares Neurogénétique, Service de Génétique Médicale, Bordeaux, France,NRGEN Team, INCIA, CNRS UMR 5287, University of Bordeaux, Bordeaux, France
| | - Cécile Courdier
- Service de Génétique Médicale, Bordeaux, France,Centre de Référence Maladies Rares Neurogénétique, Service de Génétique Médicale, Bordeaux, France,NRGEN Team, INCIA, CNRS UMR 5287, University of Bordeaux, Bordeaux, France
| | - Allan Bayat
- Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark,Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Dianalund, Denmark,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Alessandra Rossi
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Dianalund, Denmark,Pediatric Clinic, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Sophie Julia
- Service de Génétique Médicale, Pôle de Biologie, CHU de Toulouse - Hôpital Purpan, Toulouse, France
| | - Ange-Line Bruel
- Unité Fonctionnelle Innovation en Diagnostic Génomique des Maladies Rares, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France,UMR1231 GAD, Inserm - Université Bourgogne-Franche Comté, Dijon, France
| | - Frédéric Tran Mau-Them
- Unité Fonctionnelle Innovation en Diagnostic Génomique des Maladies Rares, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France,UMR1231 GAD, Inserm - Université Bourgogne-Franche Comté, Dijon, France
| | - Sophie Nambot
- UMR1231 GAD, Inserm - Université Bourgogne-Franche Comté, Dijon, France
| | - Daphné Lehalle
- Unité Fonctionnelle Innovation en Diagnostic Génomique des Maladies Rares, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France,UMR1231 GAD, Inserm - Université Bourgogne-Franche Comté, Dijon, France
| | - Marjolaine Willems
- Department of Medical Genetics, Rare diseases and Personalized Medicine, CHU Montpellier, University of Montpellier, Montpellier, France,Inserm U1298, INM, CHU Montpellier, University of Montpellier, Montpellier, France
| | - James Lespinasse
- Service de Cytogenetique, Centre Hospitalier de Chambéry, Chambéry, France
| | - Jamal Ghoumid
- Univ. Lille, ULR7364 RADEME, Lille, France,CHU Lille, Clinique de Génétique, Guy Fontaine, Lille, France
| | - Roseline Caumes
- Univ. Lille, ULR7364 RADEME, Lille, France,CHU Lille, Clinique de Génétique, Guy Fontaine, Lille, France
| | - Thomas Smol
- Univ. Lille, ULR7364 RADEME, Lille, France,CHU Lille, Institut de Génétique Médicale, Lille, France
| | - Salima El Chehadeh
- Service de Génétique Médicale, Institut de Génétique Médicale d'Alsace (IGMA), Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Elise Schaefer
- Service de Génétique Médicale, Institut de Génétique Médicale d'Alsace (IGMA), Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | | | - Boris Keren
- APHP, Département de Génétique, UF de Génomique du Développement, Département de Génétique, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Alexandra Afenjar
- Département de Génétique, Centre de Référence déficiences Intellectuelles de Causes Rares, APHP, Hôpital Armand Trousseau, Sorbonne Université, Paris, France
| | | | - Jonathan Levy
- APHP, Département de Génétique, Hôpital Robert-Debré, Paris, France
| | - Anna Maruani
- Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris, France
| | - Ángel Aledo-Serrano
- Epilepsy and Neurogenetics Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain
| | - Waltraud Garming
- Sozialpädiatrisches Zentrum, Kinder-und Jugendklinik Gelsenkirchen, Gelsenkirchen, Germany
| | | | - Anna Chassevent
- Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Marije Koopmans
- Department of Genetics, Utrecht University Medical Center, Utrecht, Netherlands
| | - Nienke E. Verbeek
- Department of Genetics, Utrecht University Medical Center, Utrecht, Netherlands
| | | | - Rebecca Belles
- Medical Genetics, Geisinger Medical Center, Danville, PA, United States
| | - Gary Bellus
- Medical Genetics, Geisinger Medical Center, Danville, PA, United States
| | - Bonnie A. Salbert
- Medical Genetics, Geisinger Medical Center, Danville, PA, United States
| | - Frank J. Kaiser
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany,Essener Zentrum für Seltene Erkrankungen (EZSE), Universitätsklinikum Essen, Essen, Germany
| | - Laure Mazzola
- Department of Neurology, University Hospital, Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, Lyon, France,Department of Neurology, University Hospital, Saint-Etienne, France
| | - Philippe Convers
- Department of Neurology, University Hospital, Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, Lyon, France,Department of Neurology, University Hospital, Saint-Etienne, France
| | - Laurine Perrin
- Department of Paediatric Physical Medicine and Rehabilitation, CHU Saint-Étienne, Hôpital Bellevue, Rhône-Alpes Reference Centre for Neuromuscular Diseases, Saint-Étienne, France
| | - Amélie Piton
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch, France,Centre National de la Recherche Scientifique, UMR7104, Illkirch, France,Institut National de la Santé et de la Recherche Médicale, U964, Illkirch, France,Université de Strasbourg, Illkirch, France
| | - Gert Wiegand
- Division of Pediatric Neurology, Department of Pediatrics, Asklepios Klinik Nord-Heidberg, Hamburg, Germany,Department of Pediatric and Adolescent Medicine II (Neuropediatrics, Social Pediatrics), University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Andrea Accogli
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montreal, Qc, Canada,Department of Human Genetics, Faculty of Medicine, McGill University, Montreal, Qc, Canada
| | - Francesco Brancati
- Department of Life, Human Genetics, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy,IRCCS San Raffaele Roma, Rome, Italy
| | - Fabio Benfenati
- Center for Synaptic Neuroscience and Technology, Istituto Italiano di Tecnologia, Geneva, Italy,IRCCS Ospedale Policlinico San Martino, Geneva, Italy
| | - Nicolas Chatron
- Service de Genetique, Hospices Civils de Lyon, Bron, France,Institute NeuroMyoGène, Laboratoire Physiopathologie et Génétique du Neurone et du Muscle, CNRS UMR 5261 -INSERM U1315, Université de Lyon - Université Claude Bernard Lyon 1, Lyon, France
| | - David Lewis-Smith
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom,Department of Clinical Neurosciences, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Rhys H. Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom,Department of Clinical Neurosciences, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Federico Zara
- IRCCS G. Gaslini, Genova, Italy,Department of Neurology, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Pasquale Striano
- IRCCS G. Gaslini, Genova, Italy,Department of Neurology, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Gaetan Lesca
- Service de Genetique, Hospices Civils de Lyon, Bron, France,Institute NeuroMyoGène, Laboratoire Physiopathologie et Génétique du Neurone et du Muscle, CNRS UMR 5261 -INSERM U1315, Université de Lyon - Université Claude Bernard Lyon 1, Lyon, France
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany,*Correspondence: Christel Depienne,
| |
Collapse
|
4
|
Peter-Derex L, Philippeau F, Garnier P, André-Obadia N, Boulogne S, Catenoix H, Convers P, Mazzola L, Gouttard M, Esteban M, Fontaine J, Mechtouff L, Ong E, Cho TH, Nighoghossian N, Perreton N, Termoz A, Haesebaert J, Schott AM, Rabilloud M, Pivot C, Dhelens C, Filip A, Berthezène Y, Rheims S, Boutitie F, Derex L. Safety and efficacy of prophylactic levetiracetam for prevention of epileptic seizures in the acute phase of intracerebral haemorrhage (PEACH): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol 2022; 21:781-791. [PMID: 35963261 DOI: 10.1016/s1474-4422(22)00235-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The incidence of early seizures (occurring within 7 days of stroke onset) after intracerebral haemorrhage reaches 30% when subclinical seizures are diagnosed by continuous EEG. Early seizures might be associated with haematoma expansion and worse neurological outcomes. Current guidelines do not recommend prophylactic antiseizure treatment in this setting. We aimed to assess whether prophylactic levetiracetam would reduce the risk of acute seizures in patients with intracerebral haemorrhage. METHODS The double-blind, randomised, placebo-controlled, phase 3 PEACH trial was conducted at three stroke units in France. Patients (aged 18 years or older) who presented with a non-traumatic intracerebral haemorrhage within 24 h after onset were randomly assigned (1:1) to levetiracetam (intravenous 500 mg every 12 h) or matching placebo. Randomisation was done with a web-based system and stratified by centre and National Institutes of Health Stroke Scale (NIHSS) score at baseline. Treatment was continued for 6 weeks. Continuous EEG was started within 24 h after inclusion and recorded over 48 h. The primary endpoint was the occurrence of at least one clinical seizure within 72 h of inclusion or at least one electrographic seizure recorded on continuous EEG, analysed in the modified intention-to-treat population, which comprised all patients who were randomly assigned to treatment and who had a continuous EEG performed. This trial was registered at ClinicalTrials.gov, NCT02631759, and is now closed. Recruitment was prematurely stopped after 48% of the recruitment target was reached due to a low recruitment rate and cessation of funding. FINDINGS Between June 1, 2017, and April 14, 2020, 50 patients with mild-to-moderate severity intracerebral haemorrhage were included: 24 were assigned to levetiracetam and 26 to placebo. During the first 72 h, a clinical or electrographic seizure was observed in three (16%) of 19 patients in the levetiracetam group versus ten (43%) of 23 patients in the placebo group (odds ratio 0·16, 95% CI 0·03-0·94, p=0·043). All seizures in the first 72 h were electrographic seizures only. No difference in depression or anxiety reporting was observed between the groups at 1 month or 3 months. Depression was recorded in three (13%) patients who received levetiracetam versus four (15%) patients who received placebo, and anxiety was reported for two (8%) patients versus one (4%) patient. The most common treatment-emergent adverse events in the levetiracetam group versus the placebo group were headache (nine [39%] vs six [24%]), pain (three [13%] vs ten [40%]), and falls (seven [30%] vs four [16%]). The most frequent serious adverse events were neurological deterioration due to the intracerebral haemorrhage (one [4%] vs four [16%]) and severe pneumonia (two [9%] vs two [8%]). No treatment-related death was reported in either group. INTERPRETATION Levetiracetam might be effective in preventing acute seizures in intracerebral haemorrhage. Larger studies are needed to determine whether seizure prophylaxis improves functional outcome in patients with intracerebral haemorrhage. FUNDING French Ministry of Health.
Collapse
Affiliation(s)
- Laure Peter-Derex
- Centre for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France.
| | - Frédéric Philippeau
- Stroke Unit, Department of Neurology, Fleyriat Hospital, Bourg en Bresse, France
| | - Pierre Garnier
- Stroke Centre, Department of Neurology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Nathalie André-Obadia
- Department of Functional Neurology and Epileptology, Lyon University Hospital, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France
| | - Sébastien Boulogne
- Department of Functional Neurology and Epileptology, Lyon University Hospital, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France
| | - Hélène Catenoix
- Department of Functional Neurology and Epileptology, Lyon University Hospital, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France
| | - Philippe Convers
- Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France; Clinical Neurophysiology Unit, Department of Neurology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Laure Mazzola
- Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France; Clinical Neurophysiology Unit, Department of Neurology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Michel Gouttard
- Stroke Unit, Department of Neurology, Fleyriat Hospital, Bourg en Bresse, France
| | - Maud Esteban
- Stroke Centre, Lyon University Hospital, Lyon, France
| | | | | | - Elodie Ong
- Stroke Centre, Lyon University Hospital, Lyon, France
| | - Tae-Hee Cho
- Stroke Centre, Lyon University Hospital, Lyon, France
| | | | - Nathalie Perreton
- Public Health Unit, Clinical Research and Epidemiology Department, Lyon University Hospital, Lyon, France; University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Anne Termoz
- Public Health Unit, Clinical Research and Epidemiology Department, Lyon University Hospital, Lyon, France; University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Julie Haesebaert
- Public Health Unit, Clinical Research and Epidemiology Department, Lyon University Hospital, Lyon, France; University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Anne-Marie Schott
- Public Health Unit, Clinical Research and Epidemiology Department, Lyon University Hospital, Lyon, France; University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Muriel Rabilloud
- Department of Biostatistics, Lyon University Hospital, Lyon, France; Biometry and Evolutionary Biology Laboratory, CNRS UMR 5558, Biostatistics Health Team, Villeurbanne, France
| | - Christine Pivot
- Pharmacy, FRIPHARM, Edouard Herriot Hospital, Lyon University Hospital, Lyon, France
| | - Carole Dhelens
- Pharmacy, FRIPHARM, Edouard Herriot Hospital, Lyon University Hospital, Lyon, France
| | - Andrea Filip
- Department of Neuroradiology, Neurological Hospital, Lyon University Hospital, Lyon, France
| | - Yves Berthezène
- Department of Neuroradiology, Neurological Hospital, Lyon University Hospital, Lyon, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Lyon University Hospital, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France
| | - Florent Boutitie
- Department of Biostatistics, Lyon University Hospital, Lyon, France; Biometry and Evolutionary Biology Laboratory, CNRS UMR 5558, Biostatistics Health Team, Villeurbanne, France
| | - Laurent Derex
- Stroke Centre, Lyon University Hospital, Lyon, France; University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| |
Collapse
|
5
|
Thirouin J, Petiot P, Antoine JC, André-Obadia N, Convers P, Gavoille A, Bouhour F, Rheims S, Camdessanché JP. Usefulness and prognostic value of diagnostic tests in patients with possible chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve 2022; 66:304-311. [PMID: 35661382 DOI: 10.1002/mus.27655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 05/23/2022] [Accepted: 05/28/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION/AIMS Recent guidelines define chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and possible CIDP. The aims of our study were to evaluate the value of diagnostic tests to support the diagnosis of CIDP in patients with possible CIDP and to identify prognostic factors of therapeutic success. METHODS We conducted an observational retrospective two-center study between 2014 and 2019. We selected patients with a clinical presentation suggesting CIDP, but whose electrodiagnostic (EDX) test results did not meet the EFNS/PNS 2021 criteria. We analyzed epidemiologic and clinical features, axonal loss on EDX, cerebrospinal fluid (CSF), somatosensory evoked potentials (SSEPs), plexus magnetic resonance imaging (MRI), nerve biopsy, and therapeutic response. RESULTS We selected 75 patients, among whom 30 (40%) responded to treatment. The positivity rates of CSF analysis, MRI and SSEPs were not influenced by the clinical presentation or by the delay between symptom onset and medical assessment. A high protein level in CSF, female gender, and a relapsing-remitting course predicted the therapeutic response. DISCUSSION It is important to properly diagnose suspected CIDP not meeting EFNS/PNS 2021 EDX criteria by using supportive criteria. Specific epidemiological factors and a raised CSF protein level predict a response to treatment. Further prospective studies are needed to improve diagnosis and the prognostic value of diagnostic tests in CIDP.
Collapse
Affiliation(s)
- Jeanne Thirouin
- Department of Neurology, Centre Hospitalier de Valence, Valence, France
| | - Philippe Petiot
- Electroneuromyography and Neuromuscular Diseases Department, Centre Médicina, Lyon, France
| | | | - Nathalie André-Obadia
- Department of Functional Neurology and Epileptology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Philippe Convers
- Department of Neurology, University Hospital, Saint-Etienne, France
| | - Antoine Gavoille
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
| | - Françoise Bouhour
- Department of Neurology, Centre Hospitalier de Valence, Valence, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | | |
Collapse
|
6
|
Bourgeois-Vionnet J, Ryvlin P, Elsensohn MH, Michel V, Valton L, Derambure P, Frazzini V, Hirsch E, Maillard L, Bartolomei F, Biberon J, Petit J, Biraben A, Crespel A, Thomas P, Lemesle-Martin M, Convers P, Leclercq M, Boulogne S, Roy P, Rheims S. Coffee consumption and seizure frequency in patients with drug-resistant focal epilepsy. Epilepsy Behav 2022; 126:108486. [PMID: 34929474 DOI: 10.1016/j.yebeh.2021.108486] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the relation between coffee consumption and seizure frequency in patients with drug-resistant focal epilepsy. METHODS Cross-sectional analysis of data collected in the SAVE study, which included patients with drug-resistant focal epilepsy during long-term EEG monitoring. Patients in whom both coffee consumption and data about seizure frequency, including focal to bilateral tonic-clonic seizures (FBTCS), were available were selected. Coffee consumption was collected using a standardized self-report questionnaire and classified into four groups: none, rare (from less than 1 cup/week to up 3 cups/week), moderate (from 4 cups/week to 3 cups/day), and high (more than 4 cups/day). RESULTS Six hundred and nineteen patients were included. There was no relation between coffee consumption and total seizure frequency (p = 0.902). In contrast, the number of FBTCS reported over the past year was significantly associated with usual coffee consumption (p = 0.029). Specifically, number of FBCTS in patients who reported moderate coffee consumption was lower than in others. In comparison with patients with moderate coffee consumption, the odds ratio (95%CI) for reporting at least 1 FBTCS per year was 1.6 (1.03-2.49) in patients who never take coffee, 1.62 (1.02-2.57) in those with rare consumption and 2.05 (1.24-3.4) in those with high consumption. Multiple ordinal logistic regression showed a trend toward an association between coffee consumption and number of FBTCS (p = 0.08). CONCLUSIONS AND RELEVANCE Our data suggest that effect of coffee consumption on seizures might depend on dose with potential benefits on FBTCS frequency at moderate doses. These results will have to be confirmed by prospective studies.
Collapse
Affiliation(s)
- Julie Bourgeois-Vionnet
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Centre Hospitalo-Universitaire Vaudois, Lausanne, Switzerland
| | - Mad-Hélénie Elsensohn
- Lyon University, Lyon, France; Équipe Biostatistique Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France; Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | | | - Luc Valton
- Clinical Neurophysiology, Department of Neurology, University Hospital of Toulouse, CerCO CNRS UMR 5549, University of Toulouse, France
| | - Philippe Derambure
- Department of Clinical Neurophysiology, Lille University Medical Center, EA 1046, University of Lille 2, France
| | - Valerio Frazzini
- Epileptology Unit, Assistance Publique-Hôpitaux de Paris, Groupe hospitalier Pitié-Salpêtrière and Brain and Spine Institute (ICM; INSERM UMRS1127, CNRS UMR7225, UPMC University Paris 06), Paris, France
| | - Edouard Hirsch
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
| | - Louis Maillard
- Neurology Department, University Hospital of Nancy, Nancy, France
| | - Fabrice Bartolomei
- Clinical Neurophysiology and Epileptology Department, Timone Hospital, Marseille, France
| | - Julien Biberon
- Department of Clinical Neurophysiology, INSERM U930, University Hospital of Tours, Tours, France
| | - Jerôme Petit
- La Teppe Epilepsy Center, Tain l'Hermitage, France
| | - Arnaud Biraben
- Department of Neurology, University Hospital of Rennes, Rennes, France
| | | | - Pierre Thomas
- Neurology Department University Hospitals of Nice, Nice, France
| | | | - Philippe Convers
- Department of Neurology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Mathilde Leclercq
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France
| | - Sébastien Boulogne
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France; Lyon's Neuroscience Research Center, INSERM U1028 / CNRS UMR 5292 and Lyon 1 University, Lyon, France
| | - Pascal Roy
- Lyon University, Lyon, France; Équipe Biostatistique Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France; Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France; Lyon's Neuroscience Research Center, INSERM U1028 / CNRS UMR 5292 and Lyon 1 University, Lyon, France; Epilepsy Institute, Lyon, France.
| | | |
Collapse
|
7
|
Lelonge Y, Karkas A, Peyron R, Reynard P, Convers P, Bertholon P. Clinical Features and Management of Drop Attacks in Menière's Disease. Special Emphasis on the Possible Occurrence of Vertigo After the Drop Attacks. Otol Neurotol 2021; 42:1269-1274. [PMID: 33973950 DOI: 10.1097/mao.0000000000003174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Tumarkin first described drop attacks (DA) in patients with a peripheral vestibular syndrome and speculated the role of a mechanical deformation of the otolith organs. We emphasized on the possible occurrence of vertigo/dizziness after a DA. In the light of the oculomotor examination of one patient right after the DA, we discussed on the mechanisms. We also described the management of DA. MATERIAL AND METHOD This study included patients with definite Meni�re's disease (MD) and at least one DA without associated neurological symptoms. Patients with vertigo/dizziness after the fall were not excluded. RESULTS Fifteen patients with MD complained of DA that was complicated either by severe head trauma (n = 1) or various fractures (n = 4). Seven patients complained of vertigo/dizziness after the DA. In one patient, DA occurred in the waiting room with a vertical illusion of movement immediately after the fall and a predominant down beating nystagmus that later changed direction. Follow up was favorable in all patients after oral medication alone (n = 7), chemical labyrinthectomy (n = 7) or vestibular neurotomy (n = 1). CONCLUSIONS We suggest that a subset of patients with MD can complain of vertigo after a DA. We conclude on the possible occurrence of a vertical mainly down beating nystagmus in MD. Since this latter nystagmus is likely related to a semicircular canal rather than an otolith dysfunction, we discuss on the mechanisms of DA followed by vertigo/dizziness. Due to the risk of trauma in DA, chemical labyrinthectomy is a reasonable and effective option although spontaneous remission is possible.
Collapse
Affiliation(s)
| | | | - Roland Peyron
- Département de Neurologie, Centre Hospitalier Universitaire de Saint Etienne, France
| | | | - Philippe Convers
- Département de Neurologie, Centre Hospitalier Universitaire de Saint Etienne, France
| | | |
Collapse
|
8
|
Szurhaj W, Leclancher A, Nica A, Périn B, Derambure P, Convers P, Mazzola L, Godet B, Faucanie M, Picot MC, De Jonckheere J. Cardiac Autonomic Dysfunction and Risk of Sudden Unexpected Death in Epilepsy. Neurology 2021; 96:e2619-e2626. [PMID: 33837114 DOI: 10.1212/wnl.0000000000011998] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/26/2021] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE We aimed to test whether patients who died of sudden unexpected death in epilepsy (SUDEP) had an abnormal cardiac autonomic response to sympathetic stimulation by hyperventilation. METHODS We conducted a retrospective, observational, case-control study of a group of patients who died of SUDEP and controls who were matched to the patients for epilepsy type, drug resistance, sex, age at EEG recording, age at onset of epilepsy, and duration of epilepsy. We analyzed the heart rate (HR) and HR variability (HRV) at rest and during and after hyperventilation performed during the patient's last EEG recording before SUDEP. In each group, changes over time in HRV indexes were analyzed with linear mixed models. RESULTS Twenty patients were included in each group. In the control group, the HR increased and the root mean square of successive RR-interval differences (RMSSD) decreased during the hyperventilation and then returned to the baseline values. In the SUDEP group, however, the HR and RMSSD did not change significantly during or after hyperventilation. A difference in HR between the end of the hyperventilation and 4 minutes after its end discriminated well between patients with SUDEP and control patients (area under the receiver operating characteristic curve 0.870, sensitivity 85%, specificity 75%). CONCLUSION Most of patients with subsequent SUDEP have an abnormal cardiac autonomic response to sympathetic stimulation through hyperventilation. An index reflecting the change in HR on hyperventilation might be predictive of the risk of SUDEP and could be used to select patients at risk of SUDEP for inclusion in trials assessing protective measures.
Collapse
Affiliation(s)
- William Szurhaj
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France.
| | - Alexandre Leclancher
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Anca Nica
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Bertille Périn
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Philippe Derambure
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Philippe Convers
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Laure Mazzola
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Bertrand Godet
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Marie Faucanie
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Marie-Christine Picot
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| | - Julien De Jonckheere
- From the Department of Clinical Neurophysiology (W.S., A.L., B.P.), Amiens University Medical Center; Equipe Chimere UR7516-Université Picardie Jules Verne (W.Z.), Amiens; Neurology Department (A.N.), Rennes University Hospital, CIC 1414, LTSI, INSERM U1099; Department of Clinical Neurophysiology (P.D.)and INSERM CIC-IT 1403 (J.D.j.), Lille University Medical Center; Neurology Department (P.C., L.M.), University Hospital, St Etienne; INSERM U 1028 (L.M.), CNRS UMR, ''Central Integration of Pain'' Group, Lyon Neuroscience Research Center; Department of Clinical Neurophysiology (B.G.), Limoges University Medical Center; and Unité de Recherche Clinique et Epidémiologie (Département Information Médicale) (M.F., M.-C.P.), CHU Montpellier, and INSERM (M.-C.P.), Centre d'Investigation Clinique 1411, Université Montpellier, France
| |
Collapse
|
9
|
Outin H, Guèye P, Alvarez V, Auvin S, Clair B, Convers P, Crespel A, Demeret S, Dupont S, Engels J, Engrand N, Freund Y, Gelisse P, Girot M, Marcoux M, Navarro V, Rossetti A, Santoli F, Sonneville R, Szurhaj W, Thomas P, Titomanlio L, Villega F, Lefort H, Peigne V. Prise en charge des états de mal épileptiques en préhospitalier, en structure d’urgence et en réanimation dans les 48 premières heures (à l’exclusion du nouveau‑né et du nourrisson). Méd Intensive Réa 2020. [DOI: 10.37051/mir-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
La Société de réanimation de langue française et la Société française de médecine d’urgence ont décidé d’élaborer denouvelles recommandations sur la prise en charge de l’état de mal épileptique (EME) avec l’ambition de répondre leplus possible aux nombreuses questions pratiques que soulèvent les EME : diagnostic, enquête étiologique, traitementnon spécifique et spécifique. Vingt‑cinq experts ont analysé la littérature scientifique et formulé des recommandationsselon la méthodologie GRADE. Les experts se sont accordés sur 96 recommandations. Les recommandations avecle niveau de preuve le plus fort ne concernent que l’EME tonicoclonique généralisé (EMETCG) : l’usage des benzodia‑zépines en première ligne (clonazépam en intraveineux [IV] direct ou midazolam en intramusculaire) est recommandé,répété cinq minutes après la première injection (à l’exception du midazolam) en cas de persistance clinique. En casde persistance cinq minutes après cette seconde injection, il est proposé d’administrer la deuxième ligne thérapeu‑tique : valproate de sodium, (fos‑)phénytoïne, phénobarbital ou lévétiracétam. La persistance avérée de convulsions30 minutes après le début de l’administration du traitement de deuxième ligne signe l’EMETCG réfractaire. Il est alorsproposé de recourir à un coma thérapeutique au moyen d’un agent anesthésique intraveineux de type midazolam oupropofol. Des recommandations spécifiques à l’enfant et aux autres EME sont aussi énoncées.
Collapse
|
10
|
Outin H, Gueye P, Alvarez V, Auvin S, Clair B, Convers P, Crespel A, Demeret S, Dupont S, Engels JC, Engrand N, Freund Y, Gelisse P, Girot M, Marcoux MO, Navarro V, Rossetti A, Santoli F, Sonneville R, Szurhaj W, Thomas P, Titomanlio L, Villega F, Lefort H, Peigne V. Recommandations Formalisées d’Experts SRLF/SFMU : Prise en charge des états de mal épileptiques en préhospitalier, en structure d’urgence et en réanimation dans les 48 premières heures (A l’exclusion du nouveau-né et du nourrisson). Ann Fr Med Urgence 2020. [DOI: 10.3166/afmu-2020-0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La Société de réanimation de langue française et la Société française de médecine d’urgence ont décidé d’élaborer de nouvelles recommandations sur la prise en charge de l’état mal épileptique (EME) avec l’ambition de répondre le plus possible aux nombreuses questions pratiques que soulèvent les EME : diagnostic, enquête étiologique, traitement non spécifique et spécifique. Vingt-cinq experts ont analysé la littérature scientifique et formulé des recommandations selon la méthodologie GRADE. Les experts se sont accordés sur 96 recommandations. Les recommandations avec le niveau de preuve le plus fort ne concernent que l’EME tonico-clonique généralisé (EMTCG) : l’usage des benzodiazépines en première ligne (clonazépam en intraveineux direct ou midazolam en intramusculaire) est recommandé, répété 5 min après la première injection (à l’exception du midazolam) en cas de persistance clinique. En cas de persistance 5 min après cette seconde injection, il est proposé d’administrer la seconde ligne thérapeutique : valproate de sodium, (fos-)phénytoïne, phénobarbital ou lévétiracétam. La persistance avérée de convulsions 30 min après le début de l’administration du traitement de deuxième ligne signe l’EMETCG réfractaire. Il est alors proposé de recourir à un coma thérapeutique au moyen d’un agent anesthésique intraveineux de type midazolam ou propofol. Des recommandations spécifiques à l’enfant et aux autres EME sont aussi énoncées.
Collapse
|
11
|
Convers P, Creac'h C, Beschet A, Laurent B, Garcia-Larrea L, Peyron R. A hidden mesencephalic variant of central pain. Eur J Pain 2020; 24:1393-1399. [PMID: 32419231 DOI: 10.1002/ejp.1588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 04/20/2020] [Accepted: 05/09/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Central post-stroke pain (CPSP) can arise after lesions anywhere in the central somatosensory pathways, essentially within the spinothalamic system (STS). Although the STS can be selectively injured in the mesencephalon, CPSP has not been described in pure midbrain infarcts. METHODS Of more than 300 CPSP consecutive cases, we describe five patients who developed definite neuropathic pain following lesions circumscribed to the postero-lateral mesencephalon. RESULTS The mesencephalic lesion responsible for pain was always haemorrhagic and always involved the spinothalamic tract (STT), as demonstrated by suppressed laser-evoked potentials in every case, with or without preserved lemniscal function. In three cases the midbrain injury could be ascribed to trauma, presumably from the cerebellar tentorium. As a result of the paucity of sensory symptoms, the pain was considered as 'psychogenic' in two of the patients until electrophysiological testing confirmed STT involvement. CONCLUSION Postero-lateral midbrain lesions should be added to potential causes of CPSP. Because pain and spinothalamic deficits may be the only clinical sign, and because small lateral midbrain lesions may be difficult to trail with MRI, mesencephalic CPSP can be misdiagnosed as malingering or psychogenic pain for years. SIGNIFICANCE Selective spinothalamic injury caused by small lateral midbrain lesions is a very rare cause of central post-stroke pain that can remain undiagnosed for years. It appears to obey to haemorrhagic, sometimes post-traumatic lesions. Sudden development of contralateral burning pain with isolated spinothalamic deficits may be the only localizing sign, which can be easily objectively detected with electrophysiological testing.
Collapse
Affiliation(s)
- Philippe Convers
- Central Integration of Pain Unit, Lyon Centre for Neurosciences (CRNL), INSERM U1028, UCB Lyon 1, UJM Saint Etienne, Saint Etienne, France.,Department of Neurology, CHU Saint Etienne, Saint Etienne, France
| | - Christelle Creac'h
- Central Integration of Pain Unit, Lyon Centre for Neurosciences (CRNL), INSERM U1028, UCB Lyon 1, UJM Saint Etienne, Saint Etienne, France.,Department of Neurology, CHU Saint Etienne, Saint Etienne, France.,Department of Pain Center, CHU Saint Etienne, Saint Etienne, France
| | | | - Bernard Laurent
- Central Integration of Pain Unit, Lyon Centre for Neurosciences (CRNL), INSERM U1028, UCB Lyon 1, UJM Saint Etienne, Saint Etienne, France.,Department of Neurology, CHU Saint Etienne, Saint Etienne, France.,Department of Pain Center, CHU Saint Etienne, Saint Etienne, France
| | - Luis Garcia-Larrea
- Central Integration of Pain Unit, Lyon Centre for Neurosciences (CRNL), INSERM U1028, UCB Lyon 1, UJM Saint Etienne, Saint Etienne, France.,Department of Neurology, CH, Valence, France
| | - Roland Peyron
- Central Integration of Pain Unit, Lyon Centre for Neurosciences (CRNL), INSERM U1028, UCB Lyon 1, UJM Saint Etienne, Saint Etienne, France.,Department of Neurology, CHU Saint Etienne, Saint Etienne, France.,Department of Pain Center, CHU Saint Etienne, Saint Etienne, France
| |
Collapse
|
12
|
Convers P, Creac’h C, Peyron R. P43-S Different stimuli painful or not may explore diffuse noxious inhibitory control in humans. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.04.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
13
|
Joubert B, Gobert F, Thomas L, Saint-Martin M, Desestret V, Convers P, Rogemond V, Picard G, Ducray F, Psimaras D, Antoine JC, Delattre JY, Honnorat J. Autoimmune episodic ataxia in patients with anti-CASPR2 antibody-associated encephalitis. Neurol Neuroimmunol Neuroinflamm 2017. [PMID: 28638854 PMCID: PMC5471489 DOI: 10.1212/nxi.0000000000000371] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To report paroxysmal episodes of cerebellar ataxia in a patient with anti–contactin-associated protein-like 2 (CASPR2) antibody-related autoimmune encephalitis and to search for similar paroxysmal ataxia in a cohort of patients with anti–CASPR2 antibody-associated autoimmune encephalitis. Methods: We report a patient with paroxysmal episodes of cerebellar ataxia observed during autoimmune encephalitis with anti-CASPR2 antibodies. In addition, clinical analysis was performed in a retrospective cohort of 37 patients with anti-CASPR2 antibodies to search for transient episodes of ataxia. Paroxysmal symptoms were further specified from the referral physicians, the patients, or their relatives. Results: A 61-year-old man with limbic encephalitis and anti-CASPR2 antibodies developed stereotyped paroxysmal episodes of cerebellar ataxia, including gait imbalance, dysarthria, and dysmetria, 1 month after the onset of the encephalitis. The ataxic episodes were specifically triggered by orthostatism and emotions. Both limbic symptoms and transient ataxic episodes resolved after treatment with steroids and IV cyclophosphamide. Among 37 other patients with anti-CASPR2 antibodies, we identified 5 additional cases with similar paroxysmal ataxic episodes that included gait imbalance (5 cases), slurred speech (3 cases), limb dysmetria (3 cases), and nystagmus (1 case). All had concomitant limbic encephalitis. Paroxysmal ataxia was not observed in patients with neuromyotonia or Morvan syndrome. Triggering factors (orthostatism or anger) were reported in 4 patients. Episodes resolved with immunomodulatory treatments in 4 patients and spontaneously in 1 case. Conclusions: Paroxysmal cerebellar ataxia must be added to the spectrum of the anti-CASPR2 antibody syndrome.
Collapse
Affiliation(s)
- Bastien Joubert
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (B.J., L.T., V.D., V.R., G.P., F.D., D.P., J.-C.A., J.-Y.D., J.H.), Service de Neuro-Réanimation (F.G.), Hôpital Neurologique, Hospices Civils de Lyon, Bron; Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310 (B.J., F.G., L.T., M.S.-M., V.D., V.R., G.P., F.D., J.H.), University of Lyon-Université Claude Bernard Lyon 1; Service de Neurologie (P.C., J.-C.A.), Hôpital Bellevue, Centre Hospitalier Universitaire de Saint-Étienne; and Département de Neurologie (D.P., J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Florent Gobert
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (B.J., L.T., V.D., V.R., G.P., F.D., D.P., J.-C.A., J.-Y.D., J.H.), Service de Neuro-Réanimation (F.G.), Hôpital Neurologique, Hospices Civils de Lyon, Bron; Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310 (B.J., F.G., L.T., M.S.-M., V.D., V.R., G.P., F.D., J.H.), University of Lyon-Université Claude Bernard Lyon 1; Service de Neurologie (P.C., J.-C.A.), Hôpital Bellevue, Centre Hospitalier Universitaire de Saint-Étienne; and Département de Neurologie (D.P., J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Laure Thomas
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (B.J., L.T., V.D., V.R., G.P., F.D., D.P., J.-C.A., J.-Y.D., J.H.), Service de Neuro-Réanimation (F.G.), Hôpital Neurologique, Hospices Civils de Lyon, Bron; Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310 (B.J., F.G., L.T., M.S.-M., V.D., V.R., G.P., F.D., J.H.), University of Lyon-Université Claude Bernard Lyon 1; Service de Neurologie (P.C., J.-C.A.), Hôpital Bellevue, Centre Hospitalier Universitaire de Saint-Étienne; and Département de Neurologie (D.P., J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Margaux Saint-Martin
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (B.J., L.T., V.D., V.R., G.P., F.D., D.P., J.-C.A., J.-Y.D., J.H.), Service de Neuro-Réanimation (F.G.), Hôpital Neurologique, Hospices Civils de Lyon, Bron; Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310 (B.J., F.G., L.T., M.S.-M., V.D., V.R., G.P., F.D., J.H.), University of Lyon-Université Claude Bernard Lyon 1; Service de Neurologie (P.C., J.-C.A.), Hôpital Bellevue, Centre Hospitalier Universitaire de Saint-Étienne; and Département de Neurologie (D.P., J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Virginie Desestret
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (B.J., L.T., V.D., V.R., G.P., F.D., D.P., J.-C.A., J.-Y.D., J.H.), Service de Neuro-Réanimation (F.G.), Hôpital Neurologique, Hospices Civils de Lyon, Bron; Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310 (B.J., F.G., L.T., M.S.-M., V.D., V.R., G.P., F.D., J.H.), University of Lyon-Université Claude Bernard Lyon 1; Service de Neurologie (P.C., J.-C.A.), Hôpital Bellevue, Centre Hospitalier Universitaire de Saint-Étienne; and Département de Neurologie (D.P., J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Philippe Convers
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (B.J., L.T., V.D., V.R., G.P., F.D., D.P., J.-C.A., J.-Y.D., J.H.), Service de Neuro-Réanimation (F.G.), Hôpital Neurologique, Hospices Civils de Lyon, Bron; Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310 (B.J., F.G., L.T., M.S.-M., V.D., V.R., G.P., F.D., J.H.), University of Lyon-Université Claude Bernard Lyon 1; Service de Neurologie (P.C., J.-C.A.), Hôpital Bellevue, Centre Hospitalier Universitaire de Saint-Étienne; and Département de Neurologie (D.P., J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Véronique Rogemond
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (B.J., L.T., V.D., V.R., G.P., F.D., D.P., J.-C.A., J.-Y.D., J.H.), Service de Neuro-Réanimation (F.G.), Hôpital Neurologique, Hospices Civils de Lyon, Bron; Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310 (B.J., F.G., L.T., M.S.-M., V.D., V.R., G.P., F.D., J.H.), University of Lyon-Université Claude Bernard Lyon 1; Service de Neurologie (P.C., J.-C.A.), Hôpital Bellevue, Centre Hospitalier Universitaire de Saint-Étienne; and Département de Neurologie (D.P., J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Géraldine Picard
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (B.J., L.T., V.D., V.R., G.P., F.D., D.P., J.-C.A., J.-Y.D., J.H.), Service de Neuro-Réanimation (F.G.), Hôpital Neurologique, Hospices Civils de Lyon, Bron; Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310 (B.J., F.G., L.T., M.S.-M., V.D., V.R., G.P., F.D., J.H.), University of Lyon-Université Claude Bernard Lyon 1; Service de Neurologie (P.C., J.-C.A.), Hôpital Bellevue, Centre Hospitalier Universitaire de Saint-Étienne; and Département de Neurologie (D.P., J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - François Ducray
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (B.J., L.T., V.D., V.R., G.P., F.D., D.P., J.-C.A., J.-Y.D., J.H.), Service de Neuro-Réanimation (F.G.), Hôpital Neurologique, Hospices Civils de Lyon, Bron; Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310 (B.J., F.G., L.T., M.S.-M., V.D., V.R., G.P., F.D., J.H.), University of Lyon-Université Claude Bernard Lyon 1; Service de Neurologie (P.C., J.-C.A.), Hôpital Bellevue, Centre Hospitalier Universitaire de Saint-Étienne; and Département de Neurologie (D.P., J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Dimitri Psimaras
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (B.J., L.T., V.D., V.R., G.P., F.D., D.P., J.-C.A., J.-Y.D., J.H.), Service de Neuro-Réanimation (F.G.), Hôpital Neurologique, Hospices Civils de Lyon, Bron; Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310 (B.J., F.G., L.T., M.S.-M., V.D., V.R., G.P., F.D., J.H.), University of Lyon-Université Claude Bernard Lyon 1; Service de Neurologie (P.C., J.-C.A.), Hôpital Bellevue, Centre Hospitalier Universitaire de Saint-Étienne; and Département de Neurologie (D.P., J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Jean-Christophe Antoine
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (B.J., L.T., V.D., V.R., G.P., F.D., D.P., J.-C.A., J.-Y.D., J.H.), Service de Neuro-Réanimation (F.G.), Hôpital Neurologique, Hospices Civils de Lyon, Bron; Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310 (B.J., F.G., L.T., M.S.-M., V.D., V.R., G.P., F.D., J.H.), University of Lyon-Université Claude Bernard Lyon 1; Service de Neurologie (P.C., J.-C.A.), Hôpital Bellevue, Centre Hospitalier Universitaire de Saint-Étienne; and Département de Neurologie (D.P., J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Jean-Yves Delattre
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (B.J., L.T., V.D., V.R., G.P., F.D., D.P., J.-C.A., J.-Y.D., J.H.), Service de Neuro-Réanimation (F.G.), Hôpital Neurologique, Hospices Civils de Lyon, Bron; Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310 (B.J., F.G., L.T., M.S.-M., V.D., V.R., G.P., F.D., J.H.), University of Lyon-Université Claude Bernard Lyon 1; Service de Neurologie (P.C., J.-C.A.), Hôpital Bellevue, Centre Hospitalier Universitaire de Saint-Étienne; and Département de Neurologie (D.P., J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Jérôme Honnorat
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (B.J., L.T., V.D., V.R., G.P., F.D., D.P., J.-C.A., J.-Y.D., J.H.), Service de Neuro-Réanimation (F.G.), Hôpital Neurologique, Hospices Civils de Lyon, Bron; Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310 (B.J., F.G., L.T., M.S.-M., V.D., V.R., G.P., F.D., J.H.), University of Lyon-Université Claude Bernard Lyon 1; Service de Neurologie (P.C., J.-C.A.), Hôpital Bellevue, Centre Hospitalier Universitaire de Saint-Étienne; and Département de Neurologie (D.P., J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| |
Collapse
|
14
|
Demarquay G, Sala E, Camdessanché JP, Guenot M, Mazzola L, Convers P. Céphalée critique : quand l’épilepsie se manifeste par une céphalée isolée. Rev Neurol (Paris) 2017. [DOI: 10.1016/j.neurol.2017.01.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
15
|
Rheims S, Valton L, Michel V, Maillard L, Navarro V, Convers P, Bartolomei F, Biraben A, Crespel A, Derambure P, de Toffol B, Hirsch E, Kahane P, Martin ML, Tourniaire D, Boulogne S, Mercier C, Roy P, Ryvlin P. Efficacy of naloxone in reducing postictal central respiratory dysfunction in patients with epilepsy: study protocol for a double-blind, randomized, placebo-controlled trial. Trials 2016; 17:529. [PMID: 27809868 PMCID: PMC5094038 DOI: 10.1186/s13063-016-1653-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 09/25/2016] [Indexed: 12/22/2022] Open
Abstract
Background Generalized tonic-clonic seizures (GTCSs) are the main risk factor for sudden unexpected death in epilepsy (SUDEP). Experimental and clinical data strongly suggest that the majority of SUDEP results from a postictal respiratory dysfunction progressing to terminal apnea. Postictal apnea could partly derive from a seizure-induced massive release of endogenous opioids. The main objective of this study is to evaluate the efficacy of an opioid antagonist, naloxone, administered in the immediate aftermath of a GTCS, in reducing the severity of the postictal central respiratory dysfunction. Methods/design The Efficacy of Naloxone in Reducing Postictal Central Respiratory Dysfunction in Patients with Epilepsy (ENALEPSY) study is a multicenter, double-blind, randomized, placebo-controlled trial conducted in patients with drug-resistant focal epilepsy who are undergoing long-term video-electroencephalogram (EEG) monitoring (LTM) in an epilepsy monitoring unit (EMU). We plan to randomize 166 patients (1:1) to receive intravenous naloxone (0.4 mg) or placebo in the immediate aftermath of a GTCS. Because inclusion in the study needs to take place prior to the occurrence of the GTCS, and because such occurrence is observed in about one-fourth of patients undergoing LTM, we plan to include a maximum of 700 patients upon admission in the EMU. The primary endpoint will be the proportion of patients whose oxygen saturation is <90 % between 1 and 3 min after the end of a GTCS. Secondary outcomes will include the following: the proportion of patients who show postictal apnea, the occurrence and duration of postictal generalized EEG suppression, the total duration of the postictal coma, postictal pain, and the number of patients who have a second GTCS within 120 min after the intravenous injection. Discussion The demonstration of naloxone’s efficacy on the severity of postictal hypoxemia will have two primary consequences. First, naloxone would be the first and only therapeutic approach that could be delivered immediately to reverse postictal apnea. Second, demonstration that an opioid antagonist can effectively reduce postictal apnea would pave the way for an assessment of a preventive therapy for SUDEP targeting the same pathophysiological pathway using oral administration of naltrexone. Trial registration ClinicalTrials.gov identifier: NCT02332447. Registered on 5 January 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1653-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France. .,Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Lyon, France. .,Epilepsy Institute (IDEE), Lyon, France.
| | - Luc Valton
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Véronique Michel
- Department of Clinical Neurophysiology, University Hospital of Bordeaux, Bordeaux, France
| | - Louis Maillard
- Department of Neurology, University Hospital of Nancy, Nancy, France
| | - Vincent Navarro
- Epileptology Unit, Assistance Publique-Hôpitaux de Paris - Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Brain and Spine Institute (ICM; INSERM UMRS1127, CNRS UMR7225), Pierre and Marie Curie University, Paris, France
| | - Philippe Convers
- Department of Clinical Neurophysiology, University Hospital, Saint-Etienne, France
| | - Fabrice Bartolomei
- Department of Clinical Neurophysiology and Epileptology, Timone Hospital, Marseille, France
| | - Arnaud Biraben
- Department of Neurology, University Hospital of Rennes, Rennes, France
| | - Arielle Crespel
- Epilepsy Unit, University Hospital of Montpellier, Montpellier, France
| | - Philippe Derambure
- Department of Clinical Neurophysiology, Lille University Medical Center, EA 1046, Lille 2 University of Health and Law, Lille, France
| | - Bertrand de Toffol
- Department of Clinical Neurophysiology, INSERM U930, University Hospital of Tours, Tours, France
| | - Edouard Hirsch
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
| | - Philippe Kahane
- Department of Neurology, Michallon Hospital, Grenoble, France.,Institute of Neurosciences, INSERM U836, Grenoble Alpes University, Grenoble, France
| | | | | | - Sébastien Boulogne
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France.,Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Lyon, France
| | | | - Pascal Roy
- Department of Biostatistics, Hospices Civils de Lyon, Lyon, France
| | - Philippe Ryvlin
- Epilepsy Institute (IDEE), Lyon, France.,Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | |
Collapse
|
16
|
Rosier C, Montavon A, Ostrowski K, Guénot M, Mazzola L, Convers P. Crises gélastiques d’origine frontale : deux cas. Neurophysiol Clin 2016. [DOI: 10.1016/j.neucli.2016.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
17
|
Chifflet J, Convers P, Peyron R, Créac’h C. Exploration des réponses nociceptives du côté sain chez des patients souffrant de douleurs unilatérales : une étude en Potentiel Evoqué Laser (PELs). Neurophysiol Clin 2016. [DOI: 10.1016/j.neucli.2016.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
18
|
Pigeon E, Convers P, Créac’h C, Peyron R. Potentiels évoqués pneumatiques : effets du CIDN et de l’habituation. Neurophysiol Clin 2016. [DOI: 10.1016/j.neucli.2016.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
19
|
Tchouata L, Lapras J, Mazzola L, Convers P. Épilepsie à l’alimentation : un cas. Neurophysiol Clin 2016. [DOI: 10.1016/j.neucli.2016.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
20
|
Vartiainen N, Perchet C, Magnin M, Creac'h C, Convers P, Nighoghossian N, Mauguière F, Peyron R, Garcia-Larrea L. Thalamic pain: anatomical and physiological indices of prediction. Brain 2016; 139:708-22. [PMID: 26912644 DOI: 10.1093/brain/awv389] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/16/2015] [Indexed: 11/14/2022] Open
Abstract
Thalamic pain is a severe and treatment-resistant type of central pain that may develop after thalamic stroke. Lesions within the ventrocaudal regions of the thalamus carry the highest risk to develop pain, but its emergence in individual patients remains impossible to predict. Because damage to the spino-thalamo-cortical system is a crucial factor in the development of central pain, in this study we combined detailed anatomical atlas-based mapping of thalamic lesions and assessment of spinothalamic integrity using quantitative sensory analysis and laser-evoked potentials in 42 thalamic stroke patients, of whom 31 had developed thalamic pain. More than 97% of lesions involved an area between 2 and 7 mm above the anterior-posterior commissural plane. Although most thalamic lesions affected several nuclei, patients with central pain showed maximal lesion convergence on the anterior pulvinar nucleus (a major spinothalamic target) while the convergence area lay within the ventral posterior lateral nucleus in pain-free patients. Both involvement of the anterior pulvinar nucleus and spinothalamic dysfunction (nociceptive thresholds, laser-evoked potentials) were significantly associated with the development of thalamic pain, whereas involvement of ventral posterior lateral nucleus and lemniscal dysfunction (position sense, graphaesthesia, pallaesthesia, stereognosis, standard somatosensory potentials) were similarly distributed in patients with or without pain. A logistic regression model combining spinothalamic dysfunction and anterior pulvinar nucleus involvement as regressors had 93% sensitivity and 87% positive predictive value for thalamic pain. Lesion of spinothalamic afferents to the posterior thalamus appears therefore determinant to the development of central pain after thalamic stroke. Sorting out of patients at different risks of developing thalamic pain may be achievable at the individual level by combining lesion localization and functional investigation of the spinothalamic system. As the methods proposed here do not need complex manipulations, they can be added to routine patients' work up, and the results replicated by other investigators in the field.
Collapse
Affiliation(s)
- Nuutti Vartiainen
- 1 Central Integration of Pain in Humans (NeuroPain), Lyon Neuroscience Research Center, Inserm U1028, CNRS UMR 5092, University Claude Bernard Lyon 1, France
| | - Caroline Perchet
- 1 Central Integration of Pain in Humans (NeuroPain), Lyon Neuroscience Research Center, Inserm U1028, CNRS UMR 5092, University Claude Bernard Lyon 1, France
| | - Michel Magnin
- 1 Central Integration of Pain in Humans (NeuroPain), Lyon Neuroscience Research Center, Inserm U1028, CNRS UMR 5092, University Claude Bernard Lyon 1, France
| | - Christelle Creac'h
- 1 Central Integration of Pain in Humans (NeuroPain), Lyon Neuroscience Research Center, Inserm U1028, CNRS UMR 5092, University Claude Bernard Lyon 1, France 2 Department of Neurology, University Hospital St Etienne, France
| | - Philippe Convers
- 1 Central Integration of Pain in Humans (NeuroPain), Lyon Neuroscience Research Center, Inserm U1028, CNRS UMR 5092, University Claude Bernard Lyon 1, France 2 Department of Neurology, University Hospital St Etienne, France
| | | | - François Mauguière
- 1 Central Integration of Pain in Humans (NeuroPain), Lyon Neuroscience Research Center, Inserm U1028, CNRS UMR 5092, University Claude Bernard Lyon 1, France 4 Pain Clinic (CETD) and Department of Neurology, Neurological Hospital, Hospices Civils de Lyon, France
| | - Roland Peyron
- 1 Central Integration of Pain in Humans (NeuroPain), Lyon Neuroscience Research Center, Inserm U1028, CNRS UMR 5092, University Claude Bernard Lyon 1, France 2 Department of Neurology, University Hospital St Etienne, France
| | - Luis Garcia-Larrea
- 1 Central Integration of Pain in Humans (NeuroPain), Lyon Neuroscience Research Center, Inserm U1028, CNRS UMR 5092, University Claude Bernard Lyon 1, France 4 Pain Clinic (CETD) and Department of Neurology, Neurological Hospital, Hospices Civils de Lyon, France
| |
Collapse
|
21
|
Pilliod J, Moutton S, Lavie J, Maurat E, Hubert C, Bellance N, Anheim M, Forlani S, Mochel F, N'Guyen K, Thauvin-Robinet C, Verny C, Milea D, Lesca G, Koenig M, Rodriguez D, Houcinat N, Van-Gils J, Durand CM, Guichet A, Barth M, Bonneau D, Convers P, Maillart E, Guyant-Marechal L, Hannequin D, Fromager G, Afenjar A, Chantot-Bastaraud S, Valence S, Charles P, Berquin P, Rooryck C, Bouron J, Brice A, Lacombe D, Rossignol R, Stevanin G, Benard G, Burglen L, Durr A, Goizet C, Coupry I. New practical definitions for the diagnosis of autosomal recessive spastic ataxia of Charlevoix-Saguenay. Ann Neurol 2015; 78:871-86. [PMID: 26288984 DOI: 10.1002/ana.24509] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 08/12/2015] [Accepted: 08/14/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is caused by mutations in the SACS gene. SACS encodes sacsin, a protein whose function remains unknown, despite the description of numerous protein domains and the recent focus on its potential role in the regulation of mitochondrial physiology. This study aimed to identify new mutations in a large population of ataxic patients and to functionally analyze their cellular effects in the mitochondrial compartment. METHODS A total of 321 index patients with spastic ataxia selected from the SPATAX network were analyzed by direct sequencing of the SACS gene, and 156 patients from the ATAXIC project presenting with congenital ataxia were investigated either by targeted or whole exome sequencing. For functional analyses, primary cultures of fibroblasts were obtained from 11 patients carrying either mono- or biallelic variants, including 1 case harboring a large deletion encompassing the entire SACS gene. RESULTS We identified biallelic SACS variants in 33 patients from SPATAX, and in 5 nonprogressive ataxia patients from ATAXIC. Moreover, a drastic and recurrent alteration of the mitochondrial network was observed in 10 of the 11 patients tested. INTERPRETATION Our results permit extension of the clinical and mutational spectrum of ARSACS patients. Moreover, we suggest that the observed mitochondrial network anomalies could be used as a trait biomarker for the diagnosis of ARSACS when SACS molecular results are difficult to interpret (ie, missense variants and heterozygous truncating variant). Based on our findings, we propose new diagnostic definitions for ARSACS using clinical, genetic, and cellular criteria.
Collapse
Affiliation(s)
- Julie Pilliod
- Rare Diseases Laboratory: Genetics and Metabolism, University of Bordeaux, Bordeaux, France
| | - Sébastien Moutton
- Rare Diseases Laboratory: Genetics and Metabolism, University of Bordeaux, Bordeaux, France.,Medical Genetics Service, Pellegrin University Hospital Center, Bordeaux, France
| | - Julie Lavie
- Rare Diseases Laboratory: Genetics and Metabolism, University of Bordeaux, Bordeaux, France
| | - Elise Maurat
- Rare Diseases Laboratory: Genetics and Metabolism, University of Bordeaux, Bordeaux, France
| | - Christophe Hubert
- Functional Genomics Center, University of Bordeaux, Bordeaux, France
| | - Nadège Bellance
- Rare Diseases Laboratory: Genetics and Metabolism, University of Bordeaux, Bordeaux, France
| | - Mathieu Anheim
- Neurology Service, Strasbourg University Hospitals, Strasbourg, France.,Molecular Cell Biology Genetics Institute, INSERM U964/CNRS UMR7104, University of Strasbourg, Illkirch-Graffenstaden, France.,Strasbourg Federation of Translational Medicine, University of Strasbourg, Illkirch-Graffenstaden, France
| | - Sylvie Forlani
- Genetics Service, Pitié-Salpêtrière Hospital, Public Hospital Network of Paris, Paris, France
| | - Fanny Mochel
- Genetics Service, Pitié-Salpêtrière Hospital, Public Hospital Network of Paris, Paris, France.,Brain and Spinal Cord Institute, INSERM U1127, CNRS UMR7225, Sorbonne Universities-Pierre and Marie Curie University, Paris, France
| | - Karine N'Guyen
- Department of Medical Genetics, Timone Hospital, Marseille, France
| | | | - Christophe Verny
- Nantes Angers le Mans University and Neurology Service, CNRS UMR6214, INSERM U1083, University Hospital Center, Angers, France
| | - Dan Milea
- Ophthalmology Service, Angers University Hospital Center, Angers, France and Singapore National Eye Centre, Singapore Eye Research Institute, Duke-National University of Singapore, Singapore
| | - Gaëtan Lesca
- Genetics Service, Lyon University Hospital Center, Lyon, France
| | - Michel Koenig
- Molecular Genetics Laboratory, INSERM U827, Montpellier Regional University Hospital Center, Montpellier, France
| | - Diana Rodriguez
- Rare Diseases Reference Center "Defects and Congenital Diseases of the Cerebellum," Armand Trousseau Hospital, Public Hospital Network of Paris, Paris, France.,Robert Debré Hospital, INSERM U1141, Paris, France.,Genetics Service, Armand Trousseau Hospital, Public Hospital Network of Paris, Paris, France
| | - Nada Houcinat
- Medical Genetics Service, Pellegrin University Hospital Center, Bordeaux, France
| | - Julien Van-Gils
- Medical Genetics Service, Pellegrin University Hospital Center, Bordeaux, France
| | - Christelle M Durand
- Rare Diseases Laboratory: Genetics and Metabolism, University of Bordeaux, Bordeaux, France
| | - Agnès Guichet
- Neuropediatrics Service, Armand Trousseau Hospital, Public Hospital Network of Paris, Sorbonne Universities-Pierre and Marie Curie University, Paris, France
| | - Magalie Barth
- Neuropediatrics Service, Armand Trousseau Hospital, Public Hospital Network of Paris, Sorbonne Universities-Pierre and Marie Curie University, Paris, France
| | - Dominique Bonneau
- Neuropediatrics Service, Armand Trousseau Hospital, Public Hospital Network of Paris, Sorbonne Universities-Pierre and Marie Curie University, Paris, France
| | - Philippe Convers
- Nantes Angers le Mans University and Department of Biochemistry and Genetics, University Hospital Center, Angers, France
| | - Elisabeth Maillart
- Clinical Neurophysiology Service, Saint-Étienne University Hospital Center, Saint-Étienne, France
| | - Lucie Guyant-Marechal
- Neurology Service, Pitié-Salpêtrière Hospital, Public Hospital Network of Paris, Paris, France
| | - Didier Hannequin
- Neurology Service, Pitié-Salpêtrière Hospital, Public Hospital Network of Paris, Paris, France
| | | | - Alexandra Afenjar
- Rare Diseases Reference Center "Defects and Congenital Diseases of the Cerebellum," Armand Trousseau Hospital, Public Hospital Network of Paris, Paris, France.,Neurologist, Caen, France
| | - Sandra Chantot-Bastaraud
- Rare Diseases Reference Center "Defects and Congenital Diseases of the Cerebellum," Armand Trousseau Hospital, Public Hospital Network of Paris, Paris, France.,Neurologist, Caen, France
| | - Stéphanie Valence
- Rare Diseases Reference Center "Defects and Congenital Diseases of the Cerebellum," Armand Trousseau Hospital, Public Hospital Network of Paris, Paris, France.,Genetics Service, Armand Trousseau Hospital, Public Hospital Network of Paris, Paris, France
| | - Perrine Charles
- Genetics Service, Pitié-Salpêtrière Hospital, Public Hospital Network of Paris, Paris, France
| | - Patrick Berquin
- Amiens University Hospital Center, Pediatric Neurology Activity Center, Amiens, France
| | - Caroline Rooryck
- Rare Diseases Laboratory: Genetics and Metabolism, University of Bordeaux, Bordeaux, France.,Medical Genetics Service, Pellegrin University Hospital Center, Bordeaux, France
| | - Julie Bouron
- Medical Genetics Service, Pellegrin University Hospital Center, Bordeaux, France
| | - Alexis Brice
- Genetics Service, Pitié-Salpêtrière Hospital, Public Hospital Network of Paris, Paris, France.,Brain and Spinal Cord Institute, INSERM U1127, CNRS UMR7225, Sorbonne Universities-Pierre and Marie Curie University, Paris, France
| | - Didier Lacombe
- Rare Diseases Laboratory: Genetics and Metabolism, University of Bordeaux, Bordeaux, France.,Medical Genetics Service, Pellegrin University Hospital Center, Bordeaux, France
| | - Rodrigue Rossignol
- Rare Diseases Laboratory: Genetics and Metabolism, University of Bordeaux, Bordeaux, France
| | - Giovanni Stevanin
- Genetics Service, Pitié-Salpêtrière Hospital, Public Hospital Network of Paris, Paris, France.,Brain and Spinal Cord Institute, INSERM U1127, CNRS UMR7225, Sorbonne Universities-Pierre and Marie Curie University, Paris, France.,Laboratory of Neurogenetics, Practical School of Higher Studies, Paris, France
| | - Giovanni Benard
- Rare Diseases Laboratory: Genetics and Metabolism, University of Bordeaux, Bordeaux, France
| | - Lydie Burglen
- Rare Diseases Reference Center "Defects and Congenital Diseases of the Cerebellum," Armand Trousseau Hospital, Public Hospital Network of Paris, Paris, France.,Robert Debré Hospital, INSERM U1141, Paris, France.,Neurologist, Caen, France
| | - Alexandra Durr
- Genetics Service, Pitié-Salpêtrière Hospital, Public Hospital Network of Paris, Paris, France.,Brain and Spinal Cord Institute, INSERM U1127, CNRS UMR7225, Sorbonne Universities-Pierre and Marie Curie University, Paris, France
| | - Cyril Goizet
- Rare Diseases Laboratory: Genetics and Metabolism, University of Bordeaux, Bordeaux, France.,Medical Genetics Service, Pellegrin University Hospital Center, Bordeaux, France
| | - Isabelle Coupry
- Rare Diseases Laboratory: Genetics and Metabolism, University of Bordeaux, Bordeaux, France
| |
Collapse
|
22
|
Morizot-Koutlidis R, André-Obadia N, Antoine JC, Attarian S, Ayache S, Azabou E, Benaderette S, Camdessanché JP, Cassereau J, Convers P, d’Anglejean J, Delval A, Durand MC, Etard O, Fayet G, Fournier E, Franques J, Gavaret M, Guehl D, Guerit JM, Krim E, Kubis N, Lacour A, Lozeron P, Mauguière F, Merle PE, Mesrati F, Mutschler V, Nicolas G, Nordine T, Pautot V, Péréon Y, Petiot P, Pouget J, Praline J, Salhi H, Trébuchon A, Tyvaert L, Vial C, Zola JM, Zyss J, Lefaucheur JP. Somatosensory evoked potentials in the assessment of peripheral neuropathies: Commented results of a survey among French-speaking practitioners and recommendations for practice. Neurophysiol Clin 2015; 45:131-42. [DOI: 10.1016/j.neucli.2015.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 12/14/2022] Open
|
23
|
Creac'H C, Bertholon A, Convers P, Garcia-Larrea L, Peyron R. Effects of aging on laser evoked potentials. Muscle Nerve 2015; 51:736-42. [DOI: 10.1002/mus.24458] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 08/27/2014] [Accepted: 09/09/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Christelle Creac'H
- Pain Center & Department of Neurology; CHU Saint-Etienne; 42055 Saint-Etienne France
- Central Integration of Pain Lab, INSERM U1028 &UMR 5292, Centre for Neuroscience of Lyon, University Claude Bernard of Lyon & University Jean Monnet; 42023 Saint-Etienne France
| | - Alexandre Bertholon
- Pain Center & Department of Neurology; CHU Saint-Etienne; 42055 Saint-Etienne France
| | - Philippe Convers
- Central Integration of Pain Lab, INSERM U1028 &UMR 5292, Centre for Neuroscience of Lyon, University Claude Bernard of Lyon & University Jean Monnet; 42023 Saint-Etienne France
| | - Luis Garcia-Larrea
- Central Integration of Pain Lab, INSERM U1028 &UMR 5292, Centre for Neuroscience of Lyon, University Claude Bernard of Lyon; 69003 Lyon France
| | - Roland Peyron
- Pain Center & Department of Neurology; CHU Saint-Etienne; 42055 Saint-Etienne France
- Central Integration of Pain Lab, INSERM U1028 &UMR 5292, Centre for Neuroscience of Lyon, University Claude Bernard of Lyon & University Jean Monnet; 42023 Saint-Etienne France
| |
Collapse
|
24
|
Rosenberg S, Périn B, Michel V, Debs R, Navarro V, Convers P. EEG in adults in the laboratory or at the patient's bedside. Neurophysiol Clin 2015; 45:19-37. [DOI: 10.1016/j.neucli.2014.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 11/03/2014] [Indexed: 12/25/2022] Open
|
25
|
Convers P, Peyron R, Créac'h C, Beschet A, Laurent B, Garcia Larrea L. LP58: A hidden mesencephalic variant of central pain. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)51050-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
26
|
Peyron R, Namous O, Convers P, Créac'h C. P1005: Allodynic evoked potentials with air-puff evoked potentials? A preliminary study in 23 patients with neuropathic pain. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)51040-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
27
|
Abstract
We report a fascinating case of a patient with a hyper empathy that appeared after resective epilepsy surgery. This behavioral modification has remained unchanged since the surgery took place 13 years ago. Recent neuropsychological objective assessments confirmed hyper empathy in a self-report questionnaire, and revealed higher affective theory of mind than controls in a "Reading the Mind in the Eyes Task." Temporal lobe epilepsy is the most common form of epilepsy and the investigation of emotional processes after surgery in these patients deserves to be related.
Collapse
Affiliation(s)
- Aurélie Richard-Mornas
- a Unit of Neuropsychology-CM2R, Department of Neurology, CHU Nord , Saint-Etienne , France
| | | | | | | | | | | |
Collapse
|
28
|
Prieur C, Convers P, Créac’h C, Peyron R. Air puff evoked potentials. Short latency responses. Normative values. Neurophysiol Clin 2013. [DOI: 10.1016/j.neucli.2013.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
29
|
Lau N, Convers P, Créac’h C, Peyron R. Air puff evoked potentials. Long latency vertex response. Normative values. Neurophysiol Clin 2013. [DOI: 10.1016/j.neucli.2013.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
30
|
Fouillet L, Convers P, Créac’h C, Camdessanché JP, Peyron R. Blink reflex: Recordings with a planar concentric electrode. Neurophysiol Clin 2013. [DOI: 10.1016/j.neucli.2013.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
31
|
Condé S, Créac'h C, Brun X, Moreau R, Convers P, Peyron R. Pneumatic evoked potential. Sensory or auditive potential? Neurophysiol Clin 2013; 43:189-95. [PMID: 23856175 DOI: 10.1016/j.neucli.2013.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 05/13/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022] Open
Abstract
STUDY AIM In this study, evoked potentials (EPs) to a pneumatic, innocuous, and calibrated stimulation of the skin were recorded in 22 volunteers. METHODS Air-puff stimuli were delivered through a home-made device (INSA de Lyon, Laboratoire Ampère, CHU de Saint-Étienne, France) synchronized with an EEG recording (Micromed(®)). RESULTS A reproducible EP was recorded in 18 out of 22 subjects (82% of cases) with a mean latency of about 120-130ms, and maximal amplitude at Cz. This EP actually consisted of two components, an auditory and a somatosensory one. Indeed, it was significantly decreased in amplitude, but did not disappear, when the noise generated by the air-puff was masked. We also verified that a stimulation close to the skin but not perceived by the subject was not associated with any EP. Conduction velocity between hand and shoulder was calculated around 25m/s. CONCLUSIONS This preliminary study demonstrates that pneumatic EPs can be recorded in normal volunteers.
Collapse
Affiliation(s)
- S Condé
- Department of Neurology, Neurophysiology and Pain Center, University Hospital, 42055 Saint-Étienne, France
| | | | | | | | | | | |
Collapse
|
32
|
Mollier-Saliner J, Thouvenin S, Darteyre S, Jaziri F, Vasselon C, Convers P, Stephan JL. Encéphalites limbiques paranéoplasiques de l’enfant : à propos de 2 observations. Arch Pediatr 2013; 20:386-90. [DOI: 10.1016/j.arcped.2013.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/01/2012] [Accepted: 01/20/2013] [Indexed: 01/28/2023]
|
33
|
Richard-Mornas A, Mazzietti A, Koenig O, Convers P, Thomas-Anterion C. Modifications comportementales après une amygdalohippocampectomie droite. Vignette clinique. Rev Neurol (Paris) 2013. [DOI: 10.1016/j.neurol.2013.01.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
34
|
Convers P. Épilepsie et troubles cognitifs chez la personne âgée : qu’apporte l’EEG ? Rev Neurol (Paris) 2012. [DOI: 10.1016/j.neurol.2012.01.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
35
|
Bourgeat F, Borg C, Bedoin N, Convers P, Billard S, Royer A, Grosselin A, Bellot C, Thomas-Antérion C. Explicit and implicit emotional processing modifications in pharmacoresistant left temporal lobe epilepsy and anxiodepressive disorders. Epilepsy Behav 2011; 21:367-72. [PMID: 21742561 DOI: 10.1016/j.yebeh.2011.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 05/03/2011] [Accepted: 06/05/2011] [Indexed: 10/18/2022]
Abstract
We examined whether anxiodepressive patients with left temporal lobe epilepsy could be differentiated from those with depression but without epilepsy on tasks that investigate attentional bias toward and explicit judgment of emotional stimuli. Eight depressive patients, eight anxiodepressive patients with epilepsy, and eight controls participated in the present study. Anxiodepressive with epilepsy and depressive patients had comparable depression scores and the same cognitive profile. Two distinct emotional tasks were used: the decision lexical task and the number comparison task. Three emotional connotations were presented: neutral, positive, and negative. The pattern of results showed an attentional bias toward negative words and pictures in depressive patients and only toward negative words in anxiodepressive patients with epilepsy. Moreover, depressive patients explicitly judged negative stimuli with lower intensity and anxiodepressive patients judged neutral stimuli with higher intensity. The present study specifies the emotional functioning in depression with or without left temporal lobe epilepsy.
Collapse
Affiliation(s)
- Fanny Bourgeat
- Unité de Neuropsychologie, CM2R, Service de Neurologie, CHU Nord, Saint-Etienne, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Condé S, Peyron R, Créac'h C, Convers P, Brun X. W10.5 Pneumatic evoked potential. Auditory and/or somatosensory EPS? Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60105-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
37
|
Camdessanché JP, Belzil VV, Jousserand G, Rouleau GA, Créac'h C, Convers P, Antoine JC. Sensory and motor neuronopathy in a patient with the A382P TDP-43 mutation. Orphanet J Rare Dis 2011; 6:4. [PMID: 21294910 PMCID: PMC3042904 DOI: 10.1186/1750-1172-6-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 02/05/2011] [Indexed: 12/12/2022] Open
Abstract
Patients with TARDBP mutations have so far been classified as ALS, sometimes with frontal lobe dysfunction. A 66-year-old patient progressively developed a severe sensory disorder, followed by a motor disorder, which evolved over nine years. Symptoms started in the left hand and slowly involved the four limbs. Investigations were consistent with a mixed sensory and motor neuronopathy. A heterozygous change from an alanine to a proline at amino acid 382 was identified in exon 6 of the TARDPB gene (p.A382P). This case expands the phenotypic spectrum associated with mutations in the TARDBP gene and shows that sensory neurons can be severely damaged early in the course of the disease, following a propagating process, with an orderly progression from a focal starting point. A combination of severe sensory and motor neuronopathy is rarely encountered in clinical practice. The possibility of an A382P TDP-43 mutation should be considered in patients with such an association.
Collapse
|
38
|
Pomares FB, Creac'h C, Faillenot I, Convers P, Peyron R. How a clock can change your pain? The illusion of duration and pain perception. Pain 2010; 152:230-234. [PMID: 21129849 DOI: 10.1016/j.pain.2010.10.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 10/26/2010] [Accepted: 10/29/2010] [Indexed: 11/26/2022]
Abstract
The intensity of experimental pain is known to be dependent on stimulation duration. However, it remains unknown whether this effect arises largely from the actual stimulus duration or is substantially influenced by the subject's perception of the stimulus duration. In the present study, we questioned this issue by misleading the perception of the duration of pain in a population of 36 healthy volunteers stimulated with a thermode. To this aim, time was signified by a clock with rotating hands in which imperceptible differences in speed rotation had been introduced. Subjects were therefore immersed in 2 comparative conditions in which time was manipulated to provide the illusion of either long or short duration of the painful stimulus. In a first condition ("full-length" clock), participants were instructed that pain would last for a complete revolution of the clock's hands, whereas in the second condition ("shortened" clock), revolution was reduced by 25%. Although the intensity and the real duration of stimulation were identical in both conditions, the intensity of pain was significantly reduced when the perception of time was misleadingly shortened by the manipulated clock. This study suggests that the perceived duration of a noxious stimulation may influence the perceived intensity of pain. The perceived duration of the length of a noxious stimulation influences (decreases) the intensity of perceived pain.
Collapse
Affiliation(s)
- Florence B Pomares
- Department of Neurology, CHU, 42055 Saint-Etienne, France Pain Center, CHU, 42055 Saint-Etienne, France INSERM U879, UCB Lyon1, UJM Saint-Etienne, France CMRR Unit, CHU, 42055 Saint-Etienne, France
| | | | | | | | | |
Collapse
|
39
|
Garcia-Larrea L, Perchet C, Creac'h C, Convers P, Peyron R, Laurent B, Mauguière F, Magnin M. Operculo-insular pain (parasylvian pain): a distinct central pain syndrome. Brain 2010; 133:2528-39. [PMID: 20724291 DOI: 10.1093/brain/awq220] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Central pain with dissociated thermoalgesic sensory loss is common in spinal and brainstem syndromes but not in cortical lesions. Out of a series of 270 patients investigated because of somatosensory abnormalities, we identified five subjects presenting with central pain and pure thermoalgesic sensory loss contralateral to cortical stroke. All of the patients had involvement of the posterior insula and inner parietal operculum. Lemniscal sensory modalities (position sense, graphaestesia, stereognosis) and somatosensory evoked potentials to non-noxious inputs were always preserved, while thermal and pain sensations were profoundly altered, and laser-evoked potentials to thermo-nocoiceptive stimuli were always abnormal. Central pain resulting from posterior parasylvian lesions appears to be a distinct entity that can be identified unambiguously on the basis of clinical, radiological and electrophysiological data. It presents with predominant or isolated deficits for pain and temperature sensations, and is paradoxically closer to pain syndromes from brainstem lesions affecting selectively the spinothalamic pathways than to those caused by focal lesions of the posterior thalamus. The term 'pseudo-thalamic' is therefore inappropriate to describe it, and we propose parasylvian or operculo-insular pain as appropriate labels. Parasylvian pain may be extremely difficult to treat; the magnitude of pain-temperature sensory disturbances may be prognostic for its development, hence the importance of early sensory assessment with quantitative methods.
Collapse
Affiliation(s)
- Luis Garcia-Larrea
- Central Integration of Pain Unit, U879 INSERM & University Claude Bernard, Lyon 1, Neurological Hospital, Lyon, France.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Camdessanché JP, Streichenberger N, Cavillon G, Rogemond V, Jousserand G, Honnorat J, Convers P, Antoine JC. Brain immunohistopathological study in a patient with anti-NMDAR encephalitis. Eur J Neurol 2010; 18:929-31. [PMID: 20722705 DOI: 10.1111/j.1468-1331.2010.03180.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE Anti-N-methyl-D-asparate (NMDA) receptor encephalitis is thought to be antibody-mediated. To perform an immunohistopathological study of the inflammatory reaction in a brain biopsy performed before immunomodulatory treatments in a patient with anti-NMDA receptor encephalitis. METHODS An immunohistochemical study was performed using CD3, CD68, CD20, CD138 and CD1a antibodies. RESULTS Prominent B-cell cuffing was present around brain vessels accompanied by some plasma cells, while macrophages and T cells were scattered throughout the brain parenchyma. CONCLUSION These findings suggest that the B cells interact with the T cells and are involved in antibody secretion by the plasma cells.
Collapse
Affiliation(s)
- J-P Camdessanché
- Service de Neurologie, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
The diagnosis of status epilepticus can be retained, wrongly, in several circumstances. Nonepileptic pseudoseizures from a psychiatric origin and some movement disorders can mimic convulsive status epilepticus. Encephalopathy of various causes (post-anoxic, metabolic, toxic, Creutzfeldt-Jakob disease) can be wrongly taken for non-convulsive status epilepticus, mainly due to inadequate interpretation of the electroencephalogram (EEG). In these encephalopathies, the existence of (non-epileptic) myoclonus and the abolition of the EEG abnormalities with the use of a benzodiazepine (without correction of the clinical symptoms) are additional confounding factors, leading to false diagnosis. Nevertheless, in general, the diagnosis of status epilepticus can be confirmed or rejected base on a combined analysis of the clinical data and the EEG.
Collapse
Affiliation(s)
- V Navarro
- Unité d'épileptologie et département de neurophysiologie clinique, bâtiment Paul-Castaigne, hôpital de la Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | | | | |
Collapse
|
42
|
Thomas Antérion C, Convers P, Desmales S, Borg C, Laurent B. An odd manifestation of the Capgras syndrome: loss of familiarity even with the sexual partner. Neurophysiol Clin 2008; 38:177-82. [PMID: 18539251 DOI: 10.1016/j.neucli.2008.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 04/11/2008] [Accepted: 04/12/2008] [Indexed: 10/22/2022] Open
Abstract
We report the case of a patient who presented visual hallucinations and identification disorders associated with a Capgras syndrome. During the Capgras periods, there was not only a misidentification of his wife's face, but also a more global perceptive and emotional sexual identification disorder. Thus, he had sexual intercourse with his wife's "double" without having the slightest recollection feeling of familiarity towards his "wife" and even changed his sexual habits. To the best of our knowledge, he is the only neurological patient who made his wife a mistress. Starting from this global familiarity loss, we discuss the mechanism of Capgras delusion with reference to the role of the implicit system of face recognition. Such behavior of familiarity loss not only with face but also with all intimacy aspects argues for a specific disconnection between the ventral visual pathway of face identification and the limbic system involved in emotional and episodic memory contents.
Collapse
Affiliation(s)
- C Thomas Antérion
- Neuropsychology Unit, Neurology Department, Bellevue Hospital, CHU de Bellevue, 25, boulevard Pasteur, Saint-Etienne, France.
| | | | | | | | | |
Collapse
|
43
|
Raillon A, Mazzola L, Convers P, Coudrot M, Morel J, Giraux P, Laurent B. MO37 Evaluation and prognosis of long latency somatosensory evoked potentials (N60) in coma. Clin Neurophysiol 2008. [DOI: 10.1016/s1388-2457(08)60148-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
44
|
Peyron R, Kupers R, Jehl J, Garcia-Larrea L, Convers P, Barral F, Laurent B. Central representation of the RIII flexion reflex associated with overt motor reaction: An fMRI study. Neurophysiol Clin 2007; 37:249-59. [DOI: 10.1016/j.neucli.2007.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 06/21/2007] [Accepted: 07/09/2007] [Indexed: 11/29/2022] Open
|
45
|
Camdessanché JP, Convers P, Antoine JC. Intérêt et limites de l’électroneuromyogramme pour explorer un membre supérieur douloureux. Presse Med 2006; 35:584-6. [PMID: 16614598 DOI: 10.1016/s0755-4982(06)74644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To study the utility of electroneuromyography in analysis of upper limb pain as a function of the existence of a diagnostic hypothesis. METHODS We retrospectively compared the consecutive electroneuromyographic examinations performed between 1 January and 30 September 2004. All recordings were performed by the same examiner in the neurophysiology clinic in the department of neurology of Saint-Etienne university hospital UHC at the request of hospital specialists or surgeon and private general practitioners. In each examination, at a minimum and regardless of the specific situation, motor conduction speed, F waves, and sensory conduction speed were recorded for the median nerve and the ulnar nerve on the right and left. For the arm in question, needle electromyography explored the muscles depending on the C5-T1 roots. RESULTS In all, 76 patients had ENMG examinations, 38 for whom the physician had a diagnostic hypothesis and 38 patients without. In the case of a diagnosis based on clinical suspicions, examination was normal in 73.7% of cases compared with 23.7% when there was a clinically based hypothesis (p<0.01). These findings did not vary significantly according to the specialization of the referring physician. CONCLUSION Electromyography and nerve conduction studies are useful to confirm a diagnosis based on patient reports and clinical data, it is not useful when no diagnosis has been suggested.
Collapse
|
46
|
Montes C, Magnin M, Maarrawi J, Frot M, Convers P, Mauguière F, Garcia-Larrea L. Thalamic thermo-algesic transmission: ventral posterior (VP) complex versus VMpo in the light of a thalamic infarct with central pain. Pain 2005; 113:223-32. [PMID: 15621383 DOI: 10.1016/j.pain.2004.09.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2004] [Revised: 09/09/2004] [Accepted: 09/16/2004] [Indexed: 10/26/2022]
Abstract
The respective roles of the ventral posterior complex (VP) and of the more recently described VMpo (posterior part of the ventral medial nucleus) as thalamic relays for pain and temperature pathways have recently been the subject of controversy. Data we obtained in one patient after a limited left thalamic infarct bring some new insights into this debate. This patient presented sudden right-sided hypesthesia for both lemniscal (touch, vibration, joint position) and spinothalamic (pain and temperature) modalities. He subsequently developed right-sided central pain with allodynia. Projection of 3D magnetic resonance images onto a human thalamic atlas revealed a lesion involving the anterior two thirds of the ventral posterior lateral nucleus (VPL) and, to a lesser extent, the ventral posterior medial (VPM) and inferior (VPI) nuclei. Conversely, the lesion did not extend posterior and ventral enough to concern the putative location of the spinothalamic-afferented nucleus VMpo. Neurophysiological studies showed a marked reduction (67%) of cortical responses depending on dorsal column-lemniscal transmission, while spinothalamic-specific, CO2-laser induced cortical responses were only moderately attenuated (33%). Our results show that the VP is definitely involved in thermo-algesic transmission in man, and that its selective lesion can lead to central pain. However, results also suggest that much of the spino-thalamo-cortical volley elicited by painful heat stimuli does not transit through VP, supporting the hypothesis that a non-VP locus lying more posteriorly in the human thalamus is important for thermo-algesic transmission.
Collapse
Affiliation(s)
- Carmen Montes
- Dept Fisiología, Universidad de Málaga, Campus de Teatinos s/n, 29080 Malaga, Spain.
| | | | | | | | | | | | | |
Collapse
|
47
|
Peyron R, Schneider F, Faillenot I, Convers P, Barral FG, Garcia-Larrea L, Laurent B. An fMRI study of cortical representation of mechanical allodynia in patients with neuropathic pain. Neurology 2004; 63:1838-46. [PMID: 15557499 DOI: 10.1212/01.wnl.0000144177.61125.85] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate cerebral activity associated with allodynia in patients with neuropathic pain. METHODS The brain responses of 27 patients with peripheral (5), spinal (3), brainstem (4), thalamic (5), lenticular (5), or cortical (5) lesions were studied with fMRI as innocuous mechanical stimuli were addressed to either the allodynic territory or the homologous contralateral region. RESULTS When applied to the normal side, brush and cold rubbing stimuli did not evoke pain and activated a somatosensory "control" network including contralateral primary (SI) and secondary (SII) somatosensory cortices and insular regions. The same stimuli became severely painful when applied to the allodynic side and activated regions in the contralateral hemisphere that mirrored the "control" network, with, however, lesser activation of the SII and insular cortices. Increased activation volumes were found in contralateral SI and primary motor cortex (MI). Whereas ipsilateral responses appeared very small and restricted after control stimuli, they represented the most salient effect of allodynia and were observed mainly in the ipsilateral parietal operculum (SII), SI, and insula. Allodynic stimuli also recruited additional responses in motor/premotor areas (MI, supplementary motor area), in regions involved in spatial attention (posterior parietal cortices), and in regions linking attention and motor control (mid-anterior cingulate cortex). CONCLUSION On a background of deafferentation in the hemisphere contralateral to stimuli, enhanced or additional responses to innocuous stimuli in the ipsilateral hemisphere may contribute to the shift of perception from innocuous toward painful and ill-defined sensations.
Collapse
Affiliation(s)
- R Peyron
- Departement de Neurologie, Hôpital de Bellevue, Bd Pasteur, 42055 Saint-Etienne, France.
| | | | | | | | | | | | | |
Collapse
|
48
|
Garcia-Larrea L, Convers P, Magnin M, André-Obadia N, Peyron R, Laurent B, Mauguière F. Laser-evoked potential abnormalities in central pain patients: the influence of spontaneous and provoked pain. Brain 2002; 125:2766-81. [PMID: 12429603 DOI: 10.1093/brain/awf275] [Citation(s) in RCA: 171] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We recorded laser-evoked cortical potentials (LEPs) in 54 consecutive patients presenting with unilateral neuropathic central pain (n = 42) or with lateralized pain of non-organic origin (n = 12). A number of cases in each group had superimposed hyperalgesia or allodynia. In patients with central pain, LEPs were significantly attenuated after stimulation over the painful territory, relative to stimulation of the homologous normal territory. LEP attenuation concerned not only patients with decreased pain/heat sensation, but also those with allodynia or hyperalgesia to laser pulses. In contrast, LEPs were never attenuated in patients with non-organic forms of pain, in whom LEPs could even be enhanced to stimulation of the painful territory. Increased responses in non-organic pain were a reminder of the cognitive modulation observed in normal subjects who direct attention to a laser stimulus. Enhanced LEPs never accompanied truly neuropathic hyperalgesia or allodynia. In central pain patients with exclusively spontaneous pain, LEP attenuation was more pronounced than that observed in those with allodynia and hyperalgesia. Patients with allodynia also presented occasionally ultra-late responses (>700 ms) to stimulation of the painful side. The hypothesis that such responses may reflect activation of a slow conducting 'medial' pain system is discussed. We conclude that, as currently recorded, LEPs essentially reflect the activity of a 'lateral' pain system subserved at the periphery by rapidly conducting A-delta fibres. They are useful to document the sensorial deficits (deafferentation) leading to neuropathic pain syndromes. Conversely, in the case of deafferentation, they fail to index adequately the affective aspects of pain sensation. On practical grounds, chronic pain coupled with reduced LEPs substantiates the diagnosis of neuropathic pain, whereas the finding of normal or enhanced LEPs to stimulation of a painful territory suggests the integrity of pain pathways, and does not support a neuropathic pathophysiology. In neuropathic cases, partial LEP preservation might increase the probability of developing provoked pain (allodynia/hyperalgesia). The possible predictive value of this phenomenon, when observed before the development of pain, remains to be demonstrated. In selected contexts (pain sine materia, non-organic anaesthesia), normal or enhanced LEPs may support a psychogenic participation in the syndrome.
Collapse
Affiliation(s)
- Luis Garcia-Larrea
- INSERM and Laboratoire de neurophysiologie humaine du CERMEP, Lyon, France.
| | | | | | | | | | | | | |
Collapse
|
49
|
Granger N, Convers P, Beauchet O, Imler D, Viallon A, Laurent B, Michel D. [First epileptic seizure in the elderly: electroclinical and etiological data in 341 patients]. Rev Neurol (Paris) 2002; 158:1088-95. [PMID: 12451341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
This study included 341 subjects aged over 60 years, 174 females and 167 males, (mean age 72-years), who experienced their first epileptic seizure and fulfilled all inclusion criteria over an 8-year period. Data were available from the physical examination, EEG, laboratory tests and CT scan or MRI for all patients. The international classification of epileptic seizures was applied, 41 p.cent of the seizures were generalized and 59 p.cent were partial. Status epilepticus occurred in 8 p.cent of the patients. The EEG recording was contributive to diagnosis or helpful for localizing the epileptic focus in 55 p.cent of the patients. Normal brain imaging was observed in 40 p.cent of the patients. The main etiology was cerebrovascular disease (33 p.cent), acute stroke (27 patients), or more often postvascular epilepsy (87 patients). Other etiologies were degenerative cortical dementia in 7 p.cent of the patients, metabolic and toxic disorders in 11 p.cent, and benign or malignant brain tumors in 6.5 p.cent. Thirty-two percent of the seizures were of unknown origin (cryptogenic seizures). No correlation was found between sex, age, and etiology. An antiepileptic drug treatment was initiated in 77 p.cent of the patients who were given either valproate (43 p.cent), carbamazepine (26 p.cent) or barbiturates (7 p.cent). These findings are in agreement with those reported in the reviewed literature.
Collapse
Affiliation(s)
- N Granger
- Service de neurologie, Hôpital Bellevue, 42055 Saint-Etienne Cedex 2, France
| | | | | | | | | | | | | |
Collapse
|
50
|
Montes C, Mertens P, Convers P, Peyron R, Sindou M, Laurent B, Mauguière F, Garcia-Larrea L. Cognitive effects of precentral cortical stimulation for pain control: an ERP study. Neurophysiol Clin 2002; 32:313-25. [PMID: 12490329 DOI: 10.1016/s0987-7053(02)00340-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Electrical stimulation of the motor cortex (MCS) is a promising and increasingly used neurosurgical technique for the control of refractory neuropathic pain. Although its mechanisms of action remain unknown, recent functional imaging data suggest involvement of the thalamus, brainstem and anterior cingulate/orbitofrontal cortex. Since some of these areas are also implicated in higher cognitive functions, notably attentional processes, we analysed cognitive ERPs and behavioural performance during an "oddball" auditory detection task in patients submitted to this procedure. Eleven consecutive patients undergoing MCS because of neuropathic refractory pain, ranging in age from 25 to 71 years, were included in the study. ERPs were obtained in all cases both during the application ("MCS-on") and within the 10 min that followed discontinuation of the procedure ("MCS-off"). In five patients, ERPs could also be obtained just before the start of MCS. When the patients' sample was taken as a whole, there were no consistent effects of MCS on the ERPs. There was, however, a significant interaction of MCS action with the patients' age, reflecting a significant delay during MCS of the cognitive responses N2 and P3 (N200 and P300) in the group of patients older than 50 years exclusively. This effect was rapidly reversible after MCS discontinuation. No MCS-related changes were observed in the N1 component. At the individual level, the effect of MCS on the endogenous ERPs was highly variable, ranging from a total stability of ERPs (mostly in younger subjects) to latency differences of tens of milliseconds in the older group. These results, together with recent experiments showing P300 alteration during repetitive transcranial stimulation, suggest that motor cortex stimulation may interfere with relatively simple cognitive processes such as those underlying target detection, and that the risk of abnormal cognitive effects related to cortical stimulation may increase with age. Although the procedure appears on the whole remarkably safe, complementary neuropsychological studies in this category of patients are advised, as well as caution to possible adverse cognitive effects when using MCS in the elderly, notably in the presence of pre-existent cerebral lesions.
Collapse
Affiliation(s)
- C Montes
- Equipe d'accueil, EA1880 UCB, Lyon, France
| | | | | | | | | | | | | | | |
Collapse
|