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Marois C, Quirins M, Seassau M, Demeret S, Demoule A, Naccache L, Weiss N. Bedside video-oculography to assess the caloric vestibulo-ocular reflex in ICU patients, a preliminary study. Rev Neurol (Paris) 2023; 179:1030-1034. [PMID: 37479626 DOI: 10.1016/j.neurol.2023.02.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 07/23/2023]
Affiliation(s)
- C Marois
- Inserm U 1127, Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, Sorbonne Université, 75013 Paris, France; Département de Neurologie, Unité de médecine intensive - réanimation à orientation neurologique, Sorbonne Université, AP-HP.SorbonneSorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France.
| | - M Quirins
- Inserm U 1127, Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, Sorbonne Université, 75013 Paris, France; Département de Neurologie, Unité de médecine intensive - réanimation à orientation neurologique, Sorbonne Université, AP-HP.SorbonneSorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - M Seassau
- Suricog, 130, rue de Lourmel, 75015 Paris, France; Institut de neurosciences translationnelles IHU-A-ICM, Paris, France
| | - S Demeret
- Département de Neurologie, Unité de médecine intensive - réanimation à orientation neurologique, Sorbonne Université, AP-HP.SorbonneSorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - A Demoule
- Inserm, UMRS_1158 Neurophysiologie respiratoire expérimentale et clinique, Sorbonne Université, Paris, France; Service de Pneumologie, médecine intensive et réanimation (Département "R3S"), AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, 75013 Paris, France
| | - L Naccache
- Inserm U 1127, Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, Sorbonne Université, 75013 Paris, France; Department of Neurophysiology, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France; Department of Neurology, Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France; Institut de neurosciences translationnelles IHU-A-ICM, Paris, France
| | - N Weiss
- Inserm U 1127, Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, Sorbonne Université, 75013 Paris, France; Département de Neurologie, Unité de médecine intensive - réanimation à orientation neurologique, Sorbonne Université, AP-HP.SorbonneSorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France; Inserm UMR_S 938, Centre de recherche Saint-Antoine (CRSA), Maladies métaboliques, biliaires et fibro-inflammatoire du foie & Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, Paris, France
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Le Guennec L, Marois C, Demeret S, Wijdicks EFM, Weiss N. Toxic-metabolic encephalopathy in adults: Critical discussion and pragmatical diagnostic approach. Rev Neurol (Paris) 2022; 178:93-104. [PMID: 34996631 DOI: 10.1016/j.neurol.2021.11.007] [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: 08/02/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
Toxic-metabolic encephalopathy (TME) results from an acute cerebral dysfunction due to different metabolic disturbances including medications or illicit-drugs. It can lead to altered consciousness, going from delirium to coma, which may require intensive care and invasive mechanical ventilation. Even if it is a life-threatening condition, TME might have an excellent prognosis if its etiology is rapidly identified and treated adequately. This review summarizes the main etiologies, their differential diagnosis, and diagnostic strategy and management of TME with a critical discussion on the definition of TME.
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Affiliation(s)
- L Le Guennec
- Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, département de neurologie, unité de Médecine Intensive Réanimation à orientation neurologique, Paris, France; Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université, Sorbonne, France
| | - C Marois
- Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, département de neurologie, unité de Médecine Intensive Réanimation à orientation neurologique, Paris, France
| | - S Demeret
- Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, département de neurologie, unité de Médecine Intensive Réanimation à orientation neurologique, Paris, France
| | - E F M Wijdicks
- Mayo Clinic, Department of Neurology, 200 First Street SW, Rochester, MN 55905, USA
| | - N Weiss
- Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université, Sorbonne, France; Sorbonne Université, AP-HP, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, département de neurologie, unité de Médecine Intensive Réanimation à orientation neurologique, Paris, France; Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
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Rohaut B, Demeret S. Shaping the future of neurocritical care in France. Rev Neurol (Paris) 2022; 178:7-8. [DOI: 10.1016/j.neurol.2022.01.004] [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] [Received: 01/18/2022] [Accepted: 01/18/2022] [Indexed: 11/16/2022]
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Weill A, Demeret S, Ingen-Housz-Oro S, Colin A, Bagate F, de Prost N, Weiss N. Axonal Guillain-Barré syndrome and toxic epidermal necrolysis: two cases. J Eur Acad Dermatol Venereol 2021; 36:e373-e376. [PMID: 34928508 DOI: 10.1111/jdv.17894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/22/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- A Weill
- Dermatology Department, Henri Mondor Hospital, AP-HP, Créteil, France.,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
| | - S Demeret
- Neurological Intensive Care, Sorbonne Université, AP-HP, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences, Département de Neurologie, Paris, France
| | - S Ingen-Housz-Oro
- Dermatology Department, Henri Mondor Hospital, AP-HP, Créteil, France.,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
| | - A Colin
- Dermatology Department, Henri Mondor Hospital, AP-HP, Créteil, France.,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
| | - F Bagate
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France.,Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, DMU MEDECINE, AP-HP, Créteil, France.,Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, Créteil, France
| | - N de Prost
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France.,Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, DMU MEDECINE, AP-HP, Créteil, France.,Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, Créteil, France
| | - N Weiss
- Neurological Intensive Care, Sorbonne Université, AP-HP, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences, Département de Neurologie, Paris, France.,Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies Métaboliques, Biliaires et Fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.,Groupe de Recherche Clinique en Reanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université, Paris, France
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Chassepot H, Plomp L, Mensi S, Psimaras D, Touat M, Alyanakian M, Louis-Leonard S, Plu I, Maisonobe T, Anquetil C, Wesner N, Champtiaux N, Rigolet A, Demeret S, Weiss N, Pinna B, Bretagne M, Salem J, Benveniste O, Allenbach Y. Myotoxicité liée aux inhibiteurs de points de contrôle immunitaire: trouble de l’appareil musculaire et/ou de la jonction neuromusculaire? Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.209] [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: 11/27/2022]
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Birnbaum S, Porcher R, Portero P, Clair B, Demeret S, Eymard B, Gargiulo M, Louët E, Berrih-Aknin S, Le Panse R, Aegerter P, Hogrel JY, Sharshar T. Home-based exercise in autoimmune myasthenia gravis: A randomized controlled trial. Neuromuscul Disord 2021; 31:726-735. [PMID: 34304969 DOI: 10.1016/j.nmd.2021.05.002] [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: 11/16/2020] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
The tolerance of exercise and its effects on quality of life in myasthenia gravis are not currently backed up by strong evidence. The aim of this study was to determine whether exercise as an adjunct therapy is well tolerated and can improve health-related quality of life (HRQoL) in stabilized, generalized autoimmune myasthenia gravis (gMG). We conducted a parallel-group, multi-center prospective RCT using computer-generated block randomization. Adults with stabilized, gMG, and no contra-indication to exercise, were eligible. Participants received usual care alone or usual care and exercise. The exercise intervention consisted of 3-weekly 40 min sessions of an unsupervised, moderate-intensity home rowing program over 3 months. The primary endpoint was the change in HRQoL from randomization to post-intervention. Assessor-blinded secondary endpoints were exercise tolerance and effects on clinical, psychological and immunological status. Of 138 patients screened between October 2014 and July 2017, 45 were randomly assigned to exercise (n = 23) or usual care (n = 20). Although exercise was well tolerated, the intention-to-treat analysis revealed no evidence of improved HRQoL compared to usual care (MGQOL-15-F; mean adjusted between-groups difference of -0.8 points, 95%CI -5.4 to 3.7). Two patients hospitalized for MG exacerbation were from the usual care group.
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Affiliation(s)
| | - R Porcher
- Hotel-Dieu Hospital Clinical Epidemiology Centre, Paris, France
| | - P Portero
- Université Paris-Est, Creteil, France
| | - B Clair
- APHP, Assistance Publique - Hopitaux de Paris, France
| | - S Demeret
- APHP, Assistance Publique - Hopitaux de Paris, France
| | - B Eymard
- Paris Descartes University Institute of Psychology, Paris, France
| | | | - E Louët
- Institute of Myology, Paris, France
| | | | - R Le Panse
- Paris Descartes University Institute of Psychology, Paris, France
| | - P Aegerter
- APHP, Assistance Publique - Hopitaux de Paris, France
| | | | - T Sharshar
- GHU-Psychiatrie & Neurosciences site Sainte-Anne 75014 Paris, France.
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Delorme C, Paccoud O, Kas A, Hesters A, Bombois S, Shambrook P, Boullet A, Doukhi D, Le Guennec L, Godefroy N, Maatoug R, Fossati P, Millet B, Navarro V, Bruneteau G, Demeret S, Pourcher V. COVID-19-related encephalopathy: a case series with brain FDG-positron-emission tomography/computed tomography findings. Eur J Neurol 2020; 27:2651-2657. [PMID: 32881133 PMCID: PMC7461074 DOI: 10.1111/ene.14478] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [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: 06/10/2020] [Accepted: 08/11/2020] [Indexed: 12/27/2022]
Abstract
Aim The aim of this paper is to describe the clinical features of COVID‐19‐related encephalopathy and their metabolic correlates using brain 2‐desoxy‐2‐fluoro‐D‐glucose (FDG)‐positron‐emission tomography (PET)/computed tomography (CT) imaging. Background and purpose A variety of neurological manifestations have been reported in association with COVID‐19. COVID‐19‐related encephalopathy has seldom been reported and studied. Methods We report four cases of COVID‐19‐related encephalopathy. The diagnosis was made in patients with confirmed COVID‐19 who presented with new‐onset cognitive disturbances, central focal neurological signs, or seizures. All patients underwent cognitive screening, brain magnetic resonance imaging (MRI), lumbar puncture, and brain 2‐desoxy‐2‐fluoro‐D‐glucose (FDG)‐positron‐emission tomography (PET)/computed tomography (CT) (FDG‐PET/CT). Results The four patients were aged 60 years or older, and presented with various degrees of cognitive impairment, with predominant frontal lobe impairment. Two patients presented with cerebellar syndrome, one patient had myoclonus, one had psychiatric manifestations, and one had status epilepticus. The delay between first COVID‐19 symptoms and onset of neurological symptoms was between 0 and 12 days. None of the patients had MRI features of encephalitis nor significant cerebrospinal fluid (CSF) abnormalities. SARS‐CoV‐2 RT‐PCR in the CSF was negative for all patients. All patients presented with a consistent brain FDG‐PET/CT pattern of abnormalities, namely frontal hypometabolism and cerebellar hypermetabolism. All patients improved after immunotherapy. Conclusions Despite varied clinical presentations, all patients presented with a consistent FDG‐PET pattern, which may reflect an immune mechanism.
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Affiliation(s)
- C Delorme
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - O Paccoud
- Department of Infectious and Tropical diseases, Sorbonne University, AP-HP, University Hospitals Pitié-Salpêtrière Charles Foix, Paris, France
| | - A Kas
- Nuclear Medicine and LIB Department, Sorbonne University, AP-HP, University Hospitals Pitié-Salpêtrière Charles Foix, INSERM U1146, Paris, France
| | - A Hesters
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - S Bombois
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - P Shambrook
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - A Boullet
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - D Doukhi
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - L Le Guennec
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - N Godefroy
- Department of Infectious and Tropical diseases, Sorbonne University, AP-HP, University Hospitals Pitié-Salpêtrière Charles Foix, Paris, France
| | - R Maatoug
- Department of adult Psychiatry, Sorbonne University, AP-HP, University Hospitals Pitié-Salpêtrière Charles Foix, Paris, France
| | - P Fossati
- Department of adult Psychiatry, Sorbonne University, AP-HP, University Hospitals Pitié-Salpêtrière Charles Foix, Paris, France
| | - B Millet
- Department of adult Psychiatry, Sorbonne University, AP-HP, University Hospitals Pitié-Salpêtrière Charles Foix, Paris, France
| | - V Navarro
- Department of Neurophysiology, Sorbonne University, AP-HP, University Hospitals Pitié-Salpêtrière Charles Foix, Paris, France
| | - G Bruneteau
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - S Demeret
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - V Pourcher
- Department of Infectious and Tropical diseases, Sorbonne University, AP-HP, University Hospitals Pitié-Salpêtrière Charles Foix, Paris, France.,Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, INSERM 1136, Paris, France
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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.
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Jaquet P, de Montmollin E, Dupuis C, Sazio C, Conrad M, Susset V, Demeret S, Tadie JM, Argaud L, Barbier F, Sarton B, Chabane R, Daubin D, Brulé N, Lerolle N, Alves M, Da Silva D, Kalioubi AE, Silva S, Bailly P, Wolff M, Bouadma L, Timsit JF, Sonneville R. Functional outcomes in adult patients with herpes simplex encephalitis admitted to the ICU: a multicenter cohort study. Intensive Care Med 2019; 45:1103-1111. [PMID: 31292686 DOI: 10.1007/s00134-019-05684-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 04/16/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE We aimed to study the association of body temperature and other admission factors with outcomes of herpes simplex encephalitis (HSE) adult patients requiring ICU admission. METHODS We conducted a retrospective multicenter study on patients diagnosed with HSE in 47 ICUs in France, between 2007 and 2017. Fever was defined as a body temperature higher or equal to 38.3 °C. Multivariate logistic regression analysis was used to identify factors associated with poor outcome at 90 days, defined by a score of 3-6 (indicating moderate-to-severe disability or death) on the modified Rankin scale. RESULTS Overall, 259 patients with a score on the Glasgow coma scale of 9 (6-12) and a body temperature of 38.7 (38.1-39.2) °C at admission were studied. At 90 days, 185 (71%) patients had a poor outcome, including 44 (17%) deaths. After adjusting for age, fever (OR = 2.21; 95% CI 1.18-4.16), mechanical ventilation (OR = 2.21; 95% CI 1.21-4.03), and MRI brain lesions > 3 lobes (OR = 3.04; 95% CI 1.35-6.81) were independently associated with poor outcome. By contrast, a direct ICU admission, as compared to initial admission to the hospital wards (i.e., indirect ICU admission), was protective (OR = 0.52; 95% CI 0.28-0.95). Sensitivity analyses performed after adjustment for functional status before admission and reason for ICU admission yielded similar results. CONCLUSIONS In HSE adult patients requiring ICU admission, several admission factors are associated with an increased risk of poor functional outcome. The identification of potentially modifiable factors, namely, elevated admission body temperature and indirect ICU admission, provides an opportunity for testing further intervention strategies.
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Affiliation(s)
- P Jaquet
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France
| | - E de Montmollin
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France.,UMR 1137, IAME, Paris Diderot University, Paris, France
| | - C Dupuis
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France.,UMR 1137, IAME, Paris Diderot University, Paris, France
| | - C Sazio
- Medical Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France
| | - M Conrad
- Medical Intensive Care Unit, Central Hospital, Nancy University Hospitals, Nancy, France
| | - V Susset
- Polyvalent Intensive Care Unit, Chambery Hospital, Chambery, France
| | - S Demeret
- Neurologic Intensive Care Unit, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - J M Tadie
- Medical Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - L Argaud
- Medical Intensive Care Unit, Edouard Herriot University Hospital, Lyon, France
| | - F Barbier
- Medical Intensive Care Unit, La Source Hospital, Orléans, France
| | - B Sarton
- Intensive Care Unit, Purpan University Hospital, Toulouse, France
| | - R Chabane
- Department of Perioperative Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - D Daubin
- Medical Intensive Care Unit, Montpellier University Hospital, Montpellier, France
| | - N Brulé
- Medical Intensive Care Unit, Nantes University Hospital, Nantes, France
| | - N Lerolle
- Medical Intensive Care Unit, CHU Angers, Angers University Hospital, Angers, France
| | - M Alves
- Polyvalent Intensive Care Unit, Poissy-Saint-Germain-en-Laye Hospital, Poissy, France
| | - D Da Silva
- Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France
| | - A El Kalioubi
- Medical Intensive Care Unit, Roger Salengro University Hospital, Lille, France
| | - S Silva
- Intensive Care Unit, Purpan University Hospital, Toulouse, France
| | - P Bailly
- Medical Intensive Care Unit, La Cavale Blanche University Hospital, Brest, France
| | - M Wolff
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France
| | - L Bouadma
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France.,UMR 1137, IAME, Paris Diderot University, Paris, France
| | - J F Timsit
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France.,UMR 1137, IAME, Paris Diderot University, Paris, France
| | - R Sonneville
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France. .,UMR1148, LVTS, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France.
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Louet E, Misdrahi S, Bedos CO, Birnbaum S, Hogrel JR, Portero P, Clair B, Eymard B, Demeret S, Bassez G, Berrih-Aknin S, Jobic A, Aegerter P, Thoumie P, Sharshar T, Gargiulo M. CONGENITAL MYASTHENIC SYNDROMES AND MYASTHENIA. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.092] [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: 12/01/2022]
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Chardain A, Mesnage V, Alamowitch S, Bourdain F, Crozier S, Lenglet T, Psimaras D, Demeret S, Graveleau P, Hoang-Xuan K, Levy R. Posterior reversible encephalopathy syndrome (PRES) and hypomagnesemia: A frequent association? Rev Neurol (Paris) 2016; 172:384-8. [PMID: 27371132 DOI: 10.1016/j.neurol.2016.06.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 01/12/2016] [Accepted: 06/03/2016] [Indexed: 11/16/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a serious neurological condition encountered in various medical fields. Pathophysiological factor(s) common to PRES cases of apparently unrelated etiologies are yet to be found. Based on the hypothesis that hypomagnesemia might participate in the cascade leading to PRES, our study sought to verify whether hypomagnesemia is frequently associated with PRES regardless of etiology. From a retrospective study of a cohort of 57 patients presenting with PRES of different etiologies, presented here are the findings of 19 patients with available serum magnesium levels (SMLs) during PRES. In the acute phase of PRES, hypomagnesemia was present in all 19 patients in spite of differences in etiology (including immunosuppressive drugs, hypertensive encephalopathy, eclampsia, systemic lupus erythematosus, iatrogenic etiology and unknown). SMLs were within normal ranges prior to PRES and below normal ranges during the first 48h of PRES, with a significant decrease in SMLs during the acute phase. In this retrospective study, constant hypomagnesemia was observed during the acute phase of PRES regardless of its etiology. These results now require larger studies to assess the particular importance of acute hypomagnesemia in PRES and especially the possible need to treat PRES with magnesium sulfate.
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Affiliation(s)
- A Chardain
- Department of Neurology, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
| | - V Mesnage
- Department of Neurology, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - S Alamowitch
- Department of Neurology, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - F Bourdain
- Department of Neurology, Centre médico-chirurgical Foch, 92150 Suresnes, France
| | - S Crozier
- Department of Cerebrovascular Emergency, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - T Lenglet
- Department of Neurology, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - D Psimaras
- Department of Neurology, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - S Demeret
- Department of Neurological Intensive Care Unit, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - P Graveleau
- Department of Neurology, Centre médico-chirurgical Foch, 92150 Suresnes, France
| | - K Hoang-Xuan
- Department of Neurology, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - R Levy
- Department of Neurology, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
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12
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Sabben C, Gales A, Demeret S, Bolgert F, Weiss N. Ventilation non invasive et myasthénie, une alternative judicieuse à la ventilation mécanique invasive ? Rev Neurol (Paris) 2013. [DOI: 10.1016/j.neurol.2013.01.118] [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]
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13
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Le Guennec L, Roos-Weil D, Mokhtari K, Chauvet D, Psimaras D, Reiner P, Demeret S, Bolgert F, Choquet S, Weiss N. Granulomatous angiitis of the CNS revealing a Hodgkin lymphoma. Neurology 2012; 80:323-4. [DOI: 10.1212/wnl.0b013e31827deb26] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Lapergue B, Demeret S, Denys V, Laplanche JL, Galanaud D, Verny M, Sazdovitch V, Baulac M, Haïk S, Hauw JJ, Bolgert F, Brandel JP, Navarro V. Sporadic Creutzfeldt-Jakob disease mimicking nonconvulsive status epilepticus. Neurology 2010; 74:1995-9. [PMID: 20445151 DOI: 10.1212/wnl.0b013e3181e39703] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- B Lapergue
- Neurological Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpétrière and Pierre et Marie Curie (Paris VI) University, Paris, France
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15
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Clair B, Demeret S, Dupont S, Tazarourte K. Prise en charge de l’état de mal tonicoclonique généralisé : stratégies thérapeutiques. Rev Neurol (Paris) 2009; 165:366-72. [DOI: 10.1016/j.neurol.2009.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 01/22/2009] [Indexed: 10/21/2022]
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16
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Weiss N, Mutlu G, Essardy F, Nacabal C, Sauves C, Bally C, Houbert M, Lecorre C, Germack V, Demeret S, Pierrot-Deseilligny C, Bolgert F. [The French version of the FOUR score: A new coma score]. Rev Neurol (Paris) 2009; 165:796-802. [PMID: 19296997 DOI: 10.1016/j.neurol.2009.01.045] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 12/30/2008] [Accepted: 01/21/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Comatose state is a major cause for admission to the intensive care unit. The most commonly used assessment score is the Glasgow coma scale (GCS). Although widely accepted, this score has several limitations. Recently, the full outline of unresponsiveness score (FOUR) has been validated and tested as reliable as the GCS. METHODS We translated this score in French and tested its reliability in a neurological critical care unit. This study included eight critical care patients and eight intensive care patients. The patients were successively evaluated by two neurologists, four experienced nurses and five inexperienced nurses; a total of 176 evaluations were performed. The weighted kappa (kappa(W)) was used to determine the reliability of the evaluation for both the FOUR score and the GCS. RESULTS The mean age of the patients was 62 years. The interobserver reliability of the French version of the FOUR score was high (kappa(W)=0.86; IC 95%: 0.83-0.89) comparable to that of the GCS (kappa(W)=0.85; IC 95%: 0.82-0.88). CONCLUSION The French version of the FOUR score has an excellent interobserver reliability. This score is easy to perform and well accepted, only requiring simple and short training.
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Affiliation(s)
- N Weiss
- hôpital de la Pitié-Salpêtrière, Paris, France
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17
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Weiss N, Hasboun D, Demeret S, Fontaine B, Bolgert F, Lyon-Caen O, Chabas D. Paroxysmal hypothermia as a clinical feature of multiple sclerosis. Neurology 2009; 72:193-5. [DOI: 10.1212/01.wnl.0000339102.12168.ee] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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18
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Weiss N, Demeret S, Wegener K, Pierrot-Deseilligny C, Bolgert F. Crise myasthénique chez le sujet de plus de 70 ans : quel pronostic après la réanimation ? Rev Neurol (Paris) 2009. [DOI: 10.1016/s0035-3787(09)70007-4] [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: 11/25/2022]
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19
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Kinugawa K, Adam J, Denys V, Demeret S, Bolgert F, Seilhean D. H - 10 Une leucoencéphalopathie révélant un lymphome intravasculaire. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90646-3] [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: 11/24/2022]
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20
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Weiss N, Demeret S, Sonneville R, Guillevin R, Bolgert F, Pierrot-Deseilligny C. Bilateral Internal Carotid Artery Dissection in Cystathionine Beta-Synthase Deficiency. Eur Neurol 2006; 55:177-8. [PMID: 16733360 DOI: 10.1159/000093579] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 03/16/2006] [Indexed: 11/19/2022]
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21
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Cochen V, Arnulf I, Demeret S, Neulat ML, Gourlet V, Drouot X, Moutereau S, Derenne JP, Similowski T, Willer JC, Pierrot-Deseiligny C, Bolgert F. Vivid dreams, hallucinations, psychosis and REM sleep in Guillain–Barré syndrome. Brain 2005; 128:2535-45. [PMID: 16000335 DOI: 10.1093/brain/awh585] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We conducted a prospective controlled study of the clinical and biological determinants of the mental status abnormalities in 139 patients with Guillain-Barré syndrome (GBS) and 55 patients without GBS placed in the intensive care unit (ICU controls). There were mental status changes in 31% of GBS patients and in 16% of controls (odds ratio = 2.3; P = 0.04). In GBS patients, they included vivid dreams (19%), illusions (30%, including an illusory body tilt), hallucinations (60%, mainly visual) and delusions (70%, mostly paranoid). They appeared a median 9 days after disease onset (range 1-40 days, during the progression or the plateau of the disease), and lasted a median 8 days. Seven (16%) patients experienced the symptoms before their admission to the ICU. Hallucinations were frequently hypnagogic, occurring as soon as the patients closed their eyes. Autonomic dysfunction, assisted ventilation and high CSF protein levels were significant risk factors for abnormal mental status in GBS patients. CSF hypocretin-1 (a hypothalamic neuropeptide deficient in narcolepsy) levels, measured in 20 patients, were lower in GBS patients with hallucinations (555 +/- 132 pg/ml) than in those without (664 +/- 71 pg/ml, P = 0.03). Since the mental status abnormalities had dream-like aspects, we examined their association with rapid eye movement sleep (REM sleep) using continuous sleep monitoring in 13 GBS patients with (n = 7) and without (n = 6) hallucinations and 6 tetraplegic ICU controls without hallucinations. Although sleep was short and fragmented in all groups, REM sleep latency was shorter in GBS patients with hallucinations (56 +/- 115 min) than in GBS patients without hallucinations (153 +/- 130 min) and in controls (207 +/- 179 min, P < 0.05). In addition, sleep structure was highly abnormal in hallucinators, with sleep onset in REM sleep periods (83%), abnormal eye movements during non-REM sleep (57%), high percentages of REM sleep without atonia (92 +/- 22%), REM sleep behaviour disorders and autonomic dysfunction (100%), reminiscent of a status dissociatus. The sleep abnormalities, that were almost absent in non-hallucinated GBS patients, were not exclusively related to ICU conditions, since they also appeared out of ICU, and were reversible, disappearing when the mental status abnormalities vanished while the patients were still in ICU. In conclusion, the mental status abnormalities experienced by GBS patients are different from the ICU delirium, are strongly associated with autonomic dysfunction, severe forms of the disease and possibly with a transitory hypocretin-1 transmission decrease. Sleep studies suggest that mental status abnormalities are wakeful dreams caused by a sleep and dream-associated disorder (status dissociatus).
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Affiliation(s)
- V Cochen
- Fédération de Neurologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France
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22
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Abstract
The finding in 1993 of a mutation of the copper zinc super oxyde dismutase (SOD1) provides a major breakthrough in the understanding of the etiopathogenic mechanism of amyotrophic lateral sclerosis. Various mechanisms are commonly implied in the motor neurons degeneration. Excitotoxicity and calcium metabolism abnormalities are one of the most frequently confirmed hypotheses. It allowed proposing riluzole which remains the only one drug proved to be active in the disease. The role of growth factors remains controversial and all therapeutic trials performed with these molecules remained negative. Oxidative stress abnormalities are demonstrated by number of studies but their direct therapeutic application remains to be demonstrated. Apoptosis and the role of mitochondria has been definitely confirmed and open a new therapeutic avenue for the next few years.
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Affiliation(s)
- G Bruneteau
- Fédération de neurologie Mazarin, Hôpital de la Salpêtrière, Paris
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23
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Pierrot-Deseilligny C, Müri RM, Ploner CJ, Gaymard B, Demeret S, Rivaud-Pechoux S. Decisional role of the dorsolateral prefrontal cortex in ocular motor behaviour. Brain 2003; 126:1460-73. [PMID: 12764065 DOI: 10.1093/brain/awg148] [Citation(s) in RCA: 231] [Impact Index Per Article: 11.0] [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
Three patients with a unilateral cortical lesion affecting the dorsolateral prefrontal cortex (DLPFC), i.e. Brodmann area 46, were tested using different paradigms of reflexive saccades (gap and overlap tasks), intentional saccades (antisaccades, memory-guided and predictive saccades) and smooth pursuit movements. Visually guided saccades with gap and overlap, latency of correct antisaccades and memory-guided saccades and the gain of smooth pursuit were normal, compared with controls. These results confirm our anatomical data showing that the adjacent frontal eye field (FEF) was unimpaired in these patients. The specific pattern of abnormalities after a unilateral DLPFC lesion, compared with that of the FEF lesions previously reported, consists mainly of: (i) a bilateral increase in the percentage of errors in the antisaccade task (misdirected reflexive saccades); (ii) a bilateral increase in the variable error in amplitude, without significant decrease in the gain, in the memory-guided saccade task; and (iii) a bilateral decrease in the percentage of anticipatory saccades in the predictive task. Taken together, these results suggest that the DLPFC plays a crucial role in the decisional processes, preparing saccades by inhibiting unwanted reflexive saccades (inhibition), maintaining memorized information for ongoing intentional saccades (short-term spatial memory) or facilitating anticipatory saccades (prediction), depending upon current external environmental and internal circumstances.
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Affiliation(s)
- C Pierrot-Deseilligny
- INSERM 289 and Service de Neurologie 1, Hôpital de la Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
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24
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Bejjani BP, Arnulf I, Houeto JL, Milea D, Demeret S, Pidoux B, Damier P, Cornu P, Dormont D, Agid Y. Concurrent excitatory and inhibitory effects of high frequency stimulation: an oculomotor study. J Neurol Neurosurg Psychiatry 2002; 72:517-22. [PMID: 11909914 PMCID: PMC1737848 DOI: 10.1136/jnnp.72.4.517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe a reversible neurological condition resembling a crossed midbrain syndrome resulting from high frequency stimulation (HFS) in the midbrain. METHODS Postoperative evaluation of quadripolar electrodes implanted in the area of the subthalamic nucleus of 25 patients with Parkinson's disease (PD) successfully treated by HFS. RESULTS Four of the 25 patients experienced reversible acute diplopia, with dystonic posture and tremor in the contralateral upper limb when the white matter between the red nucleus and the substantia nigra was stimulated. The motor signs resembled those caused by lesions of the red nucleus. The ipsilateral resting eye position was "in and down" (three patients) or "in" (one patient). Enophthalmos was seen. Abduction was impaired and vertical eye movements were limited, but adduction was spared. The movements of the controlateral eye were normal. The ocular signs could be best explained by sustained hyperactivity of the extrinsic oculomotor nerve. Simultaneous tonic contraction of the superior rectus, the inferior rectus, and inferior oblique may cause the enophthalmos and partial limitation of upward and downward eye movements. Antagonist tonic contraction of the ipsilateral medial rectus severely impairs abduction. CONCLUSION This crossed midbrain syndrome, possibly resulting from simultaneous activation of oculomotor nerve and lesion-like inhibition of the red nucleus suggests that high frequency stimulation has opposite effects on grey and white matter.
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Affiliation(s)
- B-P Bejjani
- Centre d'Investigation Clinique, Fédération de Neurologie, and INSERM U289, France
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25
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Bejjani BP, Arnulf I, Demeret S, Damier P, Bonnet AM, Houeto JL, Agid Y. Levodopa-induced dyskinesias in Parkinson's disease: is sensitization reversible? Ann Neurol 2000; 47:655-8. [PMID: 10805339] [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: 02/16/2023]
Abstract
Levodopa-induced dyskinesias (LIDs) in patients with Parkinson's disease are considered to result from the severity of dopaminergic denervation in the striatum, which is an irrevocable phenomenon, and sensitization induced by long-term intermittent administration of levodopa. Taking advantage of the 64% reduction of levodopa treatment allowed in 12 Parkinson's disease patients by continuous high-frequency stimulation of the subthalamic nucleus, we evaluated the severity of parkinsonian motor disability and LIDs during two levodopa challenges performed before the surgical implantation of the stimulation electrodes and after 8.8 months of continuous bilateral subthalamic nucleus stimulation that was interrupted 2 hours before the levodopa test. Motor disability during the "off" and "on" drug periods was unchanged. The severity of LIDs during the "on" period and dystonia during the "off" period decreased by 54% and 62%, respectively. The reduced severity of LIDs in the absence of subthalamic nucleus stimulation demonstrates that the sensitization phenomenon resulting from long-term intermittent levodopa administration is partially reversible.
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Affiliation(s)
- B P Bejjani
- Centre d'Investigation Clinique, Fédération de Neurologie and INSERM U289, Groupe-Hospitalier Pitié-Salpêtrière, Paris, France
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26
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Bejjani BP, Gervais D, Arnulf I, Papadopoulos S, Demeret S, Bonnet AM, Cornu P, Damier P, Agid Y. Axial parkinsonian symptoms can be improved: the role of levodopa and bilateral subthalamic stimulation. J Neurol Neurosurg Psychiatry 2000; 68:595-600. [PMID: 10766889 PMCID: PMC1736917 DOI: 10.1136/jnnp.68.5.595] [Citation(s) in RCA: 168] [Impact Index Per Article: 7.0] [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: 11/04/2022]
Abstract
OBJECTIVE To assess the effects of high frequency stimulation of the subthalamic nucleus (STN) on axial symptoms occurring in advanced stages of Parkinson's disease (PD). METHODS The efficacy of STN stimulation on total motor disability score (unified Parkinson's disease rating scale (UPDRS) part III) were evaluated in 10 patients with severe Parkinson's disease. The subscores were then studied separately for limb akinesia, rigidity, and tremor, which are known to respond to levodopa, and axial signs, including speech, neck rigidity, rising from a chair, posture, gait, and postural stability, which are known to respond less well to levodopa. Patients were clinically assessed in the "off" and "on" drug condition during a levodopa challenge test performed before surgical implantation of stimulation electrodes and repeated 6 months after surgery under continuous STN stimulation. A complementary score for axial symptoms from the "activities of daily living" (ADL)-that is, speech, swallowing, turning in bed, falling, walking, and freezing-was obtained from each patient's questionnaire (UPDRS, part II). RESULTS Improvements in total motor disability score (62%), limb signs (62%), and axial signs (72%) obtained with STN stimulation were statistically comparable with those obtained with levodopa during the preoperative challenge (68%, 69%, and 59%, respectively). When levodopa and STN stimulation were combined there was a further improvement in total motor disability (80%) compared with preoperative levodopa administration. This consisted largely of an additional improvement in axial signs (84%) mainly for posture and postural stability, no further improvement in levodopa responsive signs being found. Axial symptoms from the ADL showed similar additional improvement when levodopa and STN stimulation were combined. CONCLUSION These findings suggest that bilateral STN stimulation improves most axial features of Parkinson's disease and that a synergistic effect can be obtained when stimulation is used in conjunction with levodopa treatment.
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Affiliation(s)
- B P Bejjani
- Centre d'Investigation Clinique, Fédération de Neurologie and INSERM U289, France
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27
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Rivaud-Péchoux S, Vermersch AI, Gaymard B, Ploner CJ, Bejjani BP, Damier P, Demeret S, Agid Y, Pierrot-Deseilligny C. Improvement of memory guided saccades in parkinsonian patients by high frequency subthalamic nucleus stimulation. J Neurol Neurosurg Psychiatry 2000; 68:381-4. [PMID: 10675227 PMCID: PMC1736813 DOI: 10.1136/jnnp.68.3.381] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [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: 11/04/2022]
Abstract
Recent studies in the monkey suggest that the subthalamic nucleus (STN) is involved in control of eye movement, yet its functional significance in humans is unknown. Saccadic eye movements were studied in eight parkinsonian patients treated by bilateral electrical stimulation of the STN. STN stimulation improved the accuracy of memory guided saccades but not of reflexive visually guided saccades and had no effect on the antisaccade task. This study shows that, by contrast with levodopa, STN stimulation improves memory guided saccade deficits, and illustrates for the first time in humans the role of the STN in the control of purposive saccades.
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Affiliation(s)
- S Rivaud-Péchoux
- INSERM U289, Hôpital de la Salpêtrière, 47 bd de l'Hôpital, 75651 Paris Cedex 13, France.
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