Search

International audience; In the absence of specific clinical signs, imaging or biomarkers, the differential diagnosis of degenerative parkinsonian syndromes may be difficult at early stages of the disease. To reduce the risk of misdiagnosis or delayed diagnosis and referral to multiple medical centers at disease onset, easier access to expert centers should be available. To improve the initial care of parkinsonian patients, the Parkinson's disease Expert Center (PEC) at Pitié-Salpêtrière Academic Hospital has set up a specific outpatients clinic with short waiting times dedicated to the diagnosis of early Parkinson's disease and related disorders.MethodsThe PEC setup first identifies requests for diagnostic confirmation of parkinsonian syndromes, then specific outpatients clinic visits are scheduled weekly, with examinations carried out by neurologists at the PEC on a rotating schedule. Data from the first year of the new procedure were analyzed retrospectively through self-administered questionnaires sent to patients seen during this period. The main outcomes were to confirm the ability to keep to short delays for patients’ examinations and to assess patients’ satisfaction with the setup.ResultsBoth study outcomes were achieved. The creation of an outpatients clinic dedicated to the early diagnosis of parkinsonian syndromes allowed shorter delays before the first examination of 5 weeks instead of several months. Keeping to the weekly schedule and limited time taken for each visit was also achieved. Following this initial outpatients visit, diagnosis of a parkinsonian syndrome was clinically confirmed or further specified in 80% of cases. A survey of patients’ satisfaction showed a rate of over 91% in terms of the timing and course of clinical examinations at our PEC.Discussion/ConclusionThis study of our quality-improvement program for Parkinson's disease management has shown that specific consultations with shorter waiting times aiming to allow early specialized assessment of parkinsonian syndromes is beneficial for patients and reduces the risk of delayed diagnoses.

In-class courses are deserted by medical students who tend to find it more beneficial to study in books and through online material. New interactive teaching methods, such as serious games increase both performance and motivation. We developed and assessed a new teaching method for neurological semiology using the "Hat Game" as a basis.In this game, two teams of second-year medical students are playing against one another. The game is played with a deck of cards. A neurological symptom or sign is written on each card. Each team gets a predefined period of time to guess as many words as possible. One member is the clue-giver and the others are the guessers. There are three rounds: during the first round, the clue-giver uses any descriptive term he wants and as many as he wants to make his team guess the maximum number of words within the allocated time. During the second round, the clue-giver can only choose one clue-word and, during the third round, he mimes the symptom or sign. The team that has guessed the most cards wins the game. To assess the efficacy of this learning procedure, multiple choices questions (MCQs) were asked before and after the game. Exam results of second-year students on their final university Neurology exam were analyzed. A satisfaction survey was proposed to all participating students.Among 373 students, 121 volunteers (32.4%) were enrolled in the "Neurology Hat Game" and 112 attended the game. One hundred and seven of the 112 students completed the MCQs with a significant improvement in their responses after the game (P0.001). The 112 students who completed the satisfaction self-administered questionnaire were very satisfied with this funny new teaching method.Teaching neurological semiology via the "Hat Game" is an interesting method because it is student-centered, playful and complementary to the lecturer-centered courses. A randomized controlled study would be necessary to confirm these preliminary results.

Introduction En medecine, les cours facultaires sont desertes par les etudiants, qui preferent apprendre dans les livres. De nouvelles methodes d’enseignement interactives sont necessaires pour ameliorer les performances et la motivation. Objectifs Nous avons developpe et evalue une methode d’apprentissage de la semiologie neurologique basee sur le principe du jeu du chapeau. Patients et methodes Deux equipes d’etudiants jouent l’une contre l’autre. Un signe ou symptome est ecrit sur chaque carte d’une pile. Chaque equipe dispose d’un temps pre-defini pour faire deviner un maximum de mots a l’equipe adverse au cours de 3 manches : 1. par une description en utilisant tous les termes souhaites 2, avec un seul mot 3, en mimant le signe/symptome. Nous avons evalue l’efficacite de cette methode grâce a des QCM avant et apres l’enseignement, et par l’analyse des resultats aux examens de neurologie. Resultats Parmi 373 etudiants en 2e annee de medecine, 112 volontaires (32,4 %) ont participe au jeu du chapeau. Cent sept sur 112 etudiants ont complete les QCMs avant et apres l’enseignement avec une amelioration significative de leurs performances (p Discussion L’enseignement de la semiologie neurologique par le jeu du chapeau est une methode interessante car centree sur l’etudiant, amusante, et complementaire par rapport aux enseignements classiques. Notre etude presente de possibles biais de selection, et une etude controlee et randomisee serait interessante pour confirmer ces resultats preliminaires. Conclusion Le jeu du chapeau est une nouvelle methode d’enseignement efficace et amusante, qui peut etre utilisee pour l’apprentissage de la semiologie neurologique, mais qui peut egalement etre proposees pour l’enseignement d’autres specialites medicales.

Introduction Dans la maladie de Parkinson (MP), les troubles du controle des impulsions (TCI) sont frequents chez les patients traites par agonistes dopaminergiques (AD). Une heritabilite forte de ces troubles a ete suggeree dans la population generale et dans la MP. Objectifs Notre objectif etait d’identifier les genes associes aux TCI dans la MP en comparant les sequences d’exomes chez les patients avec et sans TCI. Patients et methodes Nous avons compare 36 patients parkinsoniens avec (n = 18) ou sans (n = 18) TCI apparies sur le sexe et l’âge de debut de la MP. Le sequencage a ete realise avec le kit MedExome SeqCap EZ (Roche) et le sequenceur NexSeq 500 (Illumina). Les variants avec impact fonctionnel eleve (caddscore≥12,37) ont ete selectionnes. Leur frequence allelique et leur distribution dans les pathways et les genes ont ete analysees par single et skat-O tests, puis repliquees dans la cohorte Parkinson's Progression Markers Initiative (PPMI). Resultats L’analyse de la distribution des 6953 variants selectionnes a permis d’identifier une liste de 5 pathways associes aux TCI (p Discussion Nos resultats sont coherents avec l’importance des voies de transduction dependantes de l’AMPc et de ERK demontree dans les modeles animaux d’addiction et de plasticite induite par la dopamine. La limite essentielle de cette analyse tient au faible nombre de sujets etudies, aucun des variants identifie ne passant les seuils de significativite apres correction pour comparaisons multiples. Conclusion Nos resultats suggerent que les genes impliques dans les voies de transduction en aval des recepteurs couples aux proteines G participent a la susceptibilite genetique des TCI dans la MP.Informations complementaires Michael J Fox foundation, IHU-A-ICM.