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À l'occasion des états généraux de la médecine interne, le Collège National des Enseignants de Médecine Interne (CEMI) a mené une enquête sur l'activité d'enseignement, auprès de l'ensemble des hospitalo-universitaires (HU) de médecine interne français. L'enquête a été réalisée en septembre 2023 en adressant un courriel aux 101 professeurs des universités–praticiens hospitaliers (PU–PH) et 18 maîtres de conférence des universités–praticiens hospitaliers (MCU–PH) de médecine interne de la sous-section 53-01 du conseil national des universités (CNU), ainsi qu'aux 11 internistes HU émargeant en immunologie (sous-section 47-01) ou en thérapeutique (sous-section 48-04). Soixante-treize HU (56,1 %) ont répondu à l'enquête, dont 65 PU–PH, 7 MCU–PH et 1 praticien hospitalo-universitaire (PHU). Les HU de médecine interne participent à l'enseignement facultaire : 80 % sont responsables d'enseignement, 30 % sont responsables d'année ou de cycle ou animent des commissions et 40 % ont eu ou ont un mandat d'élu à la faculté ou à l'université. Les HU de médecine interne sont investis dans l'enseignement de la sémiologie médicale au cours du premier cycle des études de médecine, mais aussi dans les formations en maïeutique, sciences pharmaceutiques, odontologie et les formations paramédicales. Ils sont très investis dans la mise en place de la réforme du second cycle et 80 % interviennent dans la préparation des Examens Cliniques Objectifs Structurés (ECOS), essentiellement comme examinateurs (90 %). Ils participent également aux enseignements utilisant la simulation (60 %), à l'enseignement aux infirmiers de pratique avancée (IPA) (25 %), à la rédaction des ouvrages du CEMI (75 %). Huit (12 %) HU de médecine interne co-animent des formations avec des patients et 26 (38 %) participent à des enseignements en master à la faculté des sciences. Enfin, 94 % sont affiliés à une unité de recherche et 48 % encadrent des étudiants en thèse d'université. Les HU de médecine interne ont un fort engagement pédagogique, en particulier dans la sémiologie et dans la réforme du second cycle des études médicales avec les ECOS et la simulation. On the occasion of the General stage meeting of Internal Medicine, the National College of Internal Medicine Teachers (CEMI) conducted a survey on teaching activity among all French university hospital (HU) internal medicine specialists. The survey was carried out in September 2023 by sending an email to 101 hospital practitioners university professors (PU–PH) and 18 hospital practitioners assistant professors (MCU–PH) of internal medicine in subsection 53-01 of the National council of universities (CNU), as well as to the 11 HU internists working in immunology (subsection 47-01) or therapeutics (subsection 48-04). Seventy-three HUs (56.1%) responded to the survey, including 65 PU–PH, 7 MCU–PH and 1 university hospital practitioner (PHU). Internal medicine HUs participate in faculty teaching: 80% are responsible for teaching, 30% are responsible for the year or cycle or lead committees and 40% have had or have an elected mandate at the faculty or at university. Internal medicine HU are involved in the teaching of semiology during the first cycle of medical studies, but also in pharmaceutical sciences, dentistry, midwifery and in paramedical training. They are very invested in the implementation of the second cycle reform and 80% are involved in the preparation of Objective Structured Clinical Examinations (ECOS), mainly as examiners (90%). They also participate in teaching using simulation (60%), teaching advanced practice nurses (IPA) (25%), and writing CEMI books (75%). For ECOS, 90% participate as examiners, 60% participate in teaching using simulation, 25% are involved in teaching advanced practice nurses (IPA), 75% participated in the writing of CEMI works. Eight (12%) internal medicine HUs co-facilitate training with patients and 26 (38%) participate in master's courses at the Faculty of Sciences. Finally, 94% are affiliated with a research unit and 48% supervise university theses students. Internal medicine universities teachers have a strong educational commitment, particularly in semiology and in the reform of the second cycle of medical studies with ECOS and simulation. [ABSTRACT FROM AUTHOR]

• Functional seizure semiology shared many similarities across socioeconomic contexts. • Generalised motor seizures were the most reported FS type in both hospitals, at 62%. • Emotional situations were the most commonly reported seizure trigger, at 18%. • Headaches were the most common type of aura, reported by 17% of participants. • Confusion/fatigue was the most reported post-ictal sign, at 58%. Our understanding of potential differences in seizure semiology among patients with functional seizures (FS), also known as psychogenic non-epileptic seizures (PNES), across socioeconomic contexts is currently limited. By examining the differences in seizure manifestations between different socioeconomic groups, we aim to enhance the understanding of how socioeconomic factors may influence FS presentation. This study aimed to describe FS semiology in patients from a private and public epilepsy monitoring units (EMUs) in Cape Town, South Africa. The study included patients with FS confirmed through video-electroencephalography (video-EEG) and without comorbid epilepsy. For this retrospective case-control study, data on seizure semiology was gathered from digital patient records, beginning with the earliest available record for each hospital. A total of 305 patients from a private hospital and 67 patients from a public hospital were eligible for the study (N = 372). The private hospital tended to report more akinetic and subjective seizure types when compared to the public hospital. Additionally, patients at the public hospital had higher odds of reporting emotional seizure triggers (aOR=2.57, 95% CI [1.03, 6.37]), loss of consciousness or awareness (aOR=2.58, 95% CI [1.07, 6.24]), and rapid post-event recovery (aOR=6.01, 95% CI [2.52, 14.34]). At the same time, they were less likely to report both short (<30 s) (aOR=0.21, 95% CI [0.08, 0.55]) and long (>5 min) seizures (aOR=0.73, 95% CI [0.13, 0.56]), amnesia for the event (aOR=0.19, 95% CI [0.09, 0.43]), ictal aphasia (aOR=0.33, 95% CI [0.14, 0.76]) or falls and drop attacks (aOR=0.43, 95% CI [0.18, 0.996]), when compared to the private hospital patients. While the seizure manifestations were largely consistent across the two socioeconomic cohorts of patients with FS, some subtle differences were observed and warrant further investigation. [ABSTRACT FROM AUTHOR]

Neonatal seizures (NS) are the most common neurological emergency in the neonatal period. The International League Against Epilepsy (ILAE) proposed a new classification of NS based on semiology and highlighted the correlation between semiology and aetiology. However, neurodevelopmental outcomes have not been comprehensively evaluated based on this new classification. To evaluate neurodevelopmental outcomes and potential risk factors for severe outcomes in NS. Patients with video electroencephalogram confirmed NS were evaluated. Seizure aetiology, cerebral magnetic resonance imaging (MRI) data, background electroencephalograms data, general movements, and neurodevelopmental outcomes were analysed. Severe outcomes were one of the following: death, cerebral palsy, Griffiths developmental quotient <70, epilepsy, deafness, or blindness. A total of 74 neonates were evaluated: 62 (83.8 %) with acute provoked NS (primarily hypoxic-ischaemic encephalopathy), and 12 (16.2 %) with neonatal-onset epilepsies (self-limited neonatal epilepsy, developmental and epileptic encephalopathy, cerebral malformations). Of these, 32 (43.2 %) had electrographic seizures, while 42 (56.7 %) had electroclinical seizures – 38 (90.5 %) were motor (42.1 % clonic) and 4 (9.5 %) were non-motor phenomena. Severe outcomes occurred in 33 of the 74 (44.6 %) participants. In multivariate analysis, neonatal-onset epilepsies (odds ratio [OR]: 1.3; 95 % confidence interval [CI]: 1.1–1.6), status epilepticus (OR: 5.4; 95 % CI: 1.5–19.9), and abnormal general movements (OR: 3.4; 95 % CI: 1.9–7.6) were associated with severe outcomes. At present, hypoxic-ischaemic encephalopathy remains the most frequent aetiology of NS. The prognosis of neonatal-onset epilepsies was worse than that of acute provoked NS, and status epilepticus was the most predictive factor for adverse outcomes. • The new International League Against Epilepsy (ILAE) classification of neonatal seizures (NS) highlighted a correlation between seizure semiology and aetiology. • In the framework of this classification, we evaluated the neurodevelopmental outcomes in patients with video electroencephalogram (EEG)-confirmed NS. • Hypoxic ischaemic encephalopathy (HIE) remains the most frequent aetiology of NS, often associated with exclusively electrographic seizures and favourable outcomes. Acute provoked NS predominantly manifest with clonic phenomena, whereas neonatal-onset epilepsy presents with spasms, tonic or sequential seizures. • Neonatal-onset epilepsy and status epilepticus were associated with severe outcomes. [ABSTRACT FROM AUTHOR]

• Anterior insular ictal symptoms combine autonomic, oro-pharyngeal, emotional symptoms and the "hand-to-throat" sign. • Posterior insular seizures imply somatosensory symptoms including pain and cephalic sensations. • Middle insular seizures combine anterior and posterior insular seizure features. To describe pure insular ictal semiology and patterns of extra-insular spread demonstrated by stereoelectroencephalography (SEEG) according to a classification based on the insular cytoarchitecture. We investigated the ictal semiology in 17 patients undergoing SEEG for insular epilepsy. The insular cortex was divided into three regions roughly overlapping with the agranular, dysgranular and granular regions. Ictal semiology was described accordingly: anterior insula (AI, short anterior and middle gyri), middle insula (MI, short posterior and long anterior gyri) and posterior insula (PI, long posterior gyrus). Awareness impairment occurred secondarily to extra-insular ictal spread. Subjective manifestations were constant. AI seizures (n = 3) presented with autonomic (increased heart rate [HR], respiratory changes), oropharyngeal (mainly throat sensations), emotional (fear, anguish) semiology and the "hand-to-throat" sign followed by frontal-like semiology. MI seizures (n = 8) presented with mainly non-painful paresthesia, some autonomic (respiratory, increased HR), oropharyngeal or thermic symptoms and early motor features with spread to the opercular cortex. PI seizures (n = 6) were characterized by somatosensory semiology, mainly paresthesia potentially painful, and cephalic sensations. Cytoarchitectonic-based classification and the corresponding ictal features support the antero-posterior grading of insular seizures and highlight specific ictal symptoms. This refinement of insular semiology can help optimize the planning of SEEG for presumed insular epilepsy. [ABSTRACT FROM AUTHOR]

This interview aims to identify the specific advances of Henri-Rousselle Hospital at the time of its direction by Doctor Georges Daumézon, during the 1970s. The testimony of Jean-Michel Gentizon, Assistant at Henri-Rousselle Hospital between 1972 and 1976, which situates the historical context through the influential works of this period, allows us to progressively identify the stakes and the consequences of Georges Daumézon's action on French psychiatry. The policy of opening up to the different fields of psychiatry advocated by Georges Daumézon at Henri-Rousselle Hospital allows us to identify its essential function for French psychiatry in the 1970s. This institution proved to be a particularly innovative hub, soliciting the interventions of the great figures of psychiatry of this period. Its influence concerns the policy of the sector, the institutional psychotherapy movement, the field of clinical research, and the general political consequences of this action. The interview in its conclusion questions the current evolution of psychiatry, the less favorable opening modalities in the following decades, a lesser dialogue between the different currents, and the risks of a more recent narrowing of the current fields of research to the neurosciences alone. The experience of Henri-Rousselle Hospital, as developed by Dr. Georges Daumézon, proves to be a particularly favorable illustration of a policy of opening up psychiatry to the different currents of its time as well as to the different registers of the human sciences. [ABSTRACT FROM AUTHOR]

• A careful semiology analysis can help distinguish between ETS and NTE in the ICU. • Eyelids open, upper extremity abduction, plus elevation had 100% PPV for ETS. • Bilateral upper extremities extension, internal rotation, plus adduction had 90.9% PPV for NTE. • Symmetrical tonic seizures are more likely to have a generalized onset. Our primary aim was to analyze bilateral epileptic tonic seizures (ETS) and bilateral non-epileptic tonic events (NTE) in critically ill patients. Our secondary aim was to analyze ETS per their epileptogenic zone. We performed a retrospective analysis of clinical signs in patients with bilateral ETS and NTE. Two authors independently reviewed 34 videos of ETS in 34 patients and 15 videos of NTEs in 15 patients. Initial screening and review was performed in an unblinded manner. Subsequently, the semiology was characterized independently and blindly by a co-author. Statistical analysis was conducted using Bonferroni correction and two-tailed Fischer exact test. Positive predictive value (PPV) was calculated for all signs. Cluster analysis of signs with a PPV >80% was performed to evaluate co-occurring semiological features in the two groups. Compared to patients with ETS, those with NTEs more frequently had predominant involvement of proximal upper extremities (UE) (67% vs. 21%), internal rotation of UE (67% vs. 3%), adduction of UE (80% vs. 6%) and bilateral elbow extension (80% vs. 6%). In contrast, those with ETS more frequently had abduction of UE (82% vs 0%), elevation of UE (91% vs. 33%), open eyelids (74% vs. 20%), and involvement of both proximal and distal UE (79% vs. 27%). In addition, seizures that remained symmetrical throughout were more likely to have a generalized onset than focal (38% vs. 6%), p = 0.032, PPV 86%. A careful analysis of semiology can often help differentiate between ETS and NTE in the ICU. The combination of eyelids open, upper extremity abduction, and elevation reached a PPV of 100% for ETS. The combination of bilateral arms extension, internal rotation, and adduction reached a PPV of 90.9% for NTE. [ABSTRACT FROM AUTHOR]

Cet entretien se propose de cerner les avancées spécifiques de l'Hôpital Henri-Rousselle au moment de sa direction par le Docteur Georges Daumézon, au cours des années 1970. Le témoignage de Jean-Michel Gentizon, Assistant de l'Hôpital Henri-Rousselle entre 1972 et 1976, permet, en situant le contexte historique par le biais des ouvrages influents de cette période, de cerner progressivement les enjeux et les conséquences sur la psychiatrie française de l'action de Georges Daumézon. La politique d'ouverture aux différents champs de la psychiatrie prônée par Georges Daumézon à l'Hôpital Henri-Rousselle permet d'en cerner la fonction essentielle pour la psychiatrie française des années 1970. Cette institution se révèle une plaque tournante particulièrement novatrice, sollicitant les interventions des grandes figures de la psychiatrie de cette période. Son influence concerne la politique de secteur, le mouvement de la psychothérapie institutionnelle, le domaine de la recherche clinique et les conséquences politiques générales de cette action. L'entretien dans sa conclusion interroge l'évolution actuelle de la psychiatrie, des modalités d'ouverture moins favorables dans les décennies suivantes, d'un moindre dialogue entre les différents courants et les risques d'un rétrécissement plus récent des champs actuels de la recherche aux seules neurosciences. L'expérience de l'Hôpital Henri-Rousselle telle qu'elle a pu être développée par le Docteur Georges Daumézon, se révèle une illustration particulièrement favorable d'une politique d'ouverture de la psychiatrie aux différents courants de son époque comme aux différents registres des sciences humaines. This interview aims to identify the specific advances of Henri-Rousselle Hospital at the time of its direction by Doctor Georges Daumézon, during the 1970s. The testimony of Jean-Michel Gentizon, Assistant at Henri-Rousselle Hospital between 1972 and 1976, which situates the historical context through the influential works of this period, allows us to progressively identify the stakes and the consequences of Georges Daumézon's action on French psychiatry. The policy of opening up to the different fields of psychiatry advocated by Georges Daumézon at Henri-Rousselle Hospital allows us to identify its essential function for French psychiatry in the 1970s. This institution proved to be a particularly innovative hub, soliciting the interventions of the great figures of psychiatry of this period. Its influence concerns the policy of the sector, the institutional psychotherapy movement, the field of clinical research, and the general political consequences of this action. The interview in its conclusion questions the current evolution of psychiatry, the less favorable opening modalities in the following decades, a lesser dialogue between the different currents, and the risks of a more recent narrowing of the current fields of research to the neurosciences alone. The experience of Henri-Rousselle Hospital, as developed by Dr. Georges Daumézon, proves to be a particularly favorable illustration of a policy of opening up psychiatry to the different currents of its time as well as to the different registers of the human sciences. [ABSTRACT FROM AUTHOR]

This article explores the semiological value of contact and of the gaze in clinical practices. It questions the subjectivity involved in the caregiver/patient relationship and in nosography. The authors examine the place of the gaze based on writings of 19th century alienists. Then, they question the clinician's subjective experience – through the concepts of "sentiment" (Binswanger, Minkowski) and "praecox Gefühl" (Rümke) from the accounts of early stages of the clinical encounter. The gaze plays a specific role in the early stages of the clinical encounter, especially in the landscape of schizophrenia. A draft classification of different types of gazes (off-center gaze, white gaze, ecstatic gaze, black gaze) is proposed, then nuanced. Any attempt to classify the gaze leads to the deconstruction of any fixed typology. The gaze resists verbalization and even meaning, and in this, belongs to the dimension of anguish, an essential affect in a practice that does not seek to do away with relationship. At a time of increasing research in "eye movement abnormalities" in schizophrenia, it seems essential to renew our interest in the relational and therefore subjective – dimension as a specificity in clinical psychiatry. The gaze, then, would be this area without a place, this primary area of contact where relationship begins or not. [ABSTRACT FROM AUTHOR]

• The insula is anatomically concealed, so as physiologically, with a cryptic role in epilepsy. • Its heterogenous semiology makes the insula a great masquerade of other epilepsies. • With extensive connections, it serves as a crucial node and relay station within epilepsy networks. • Invasive SEEG monitoring is the gold standard technique for diagnosing insular onset epilepsy. • Insular resection remains the treatment of choice albeit MRgFUS holds promise for the future. Despite significant advances in epileptology, there are still many uncertainties about the role of the insula in epilepsy. Until recently, most insular onset seizures were wrongly attributed to the temporal lobe. Further, there are no standardised approaches to the diagnosis and treatment of insular onset seizures. This systematic review gathers the available information about insular epilepsy and synthesizes current knowledge as a basis for future research. Adhering to the PRISMA guidelines, studies were meticulously extracted from the PubMed database. The empirical data pertaining to the semiology of insular seizures, insular networks in epilepsy, techniques of mapping the insula, and the surgical intricacies of non-lesional insular epilepsy were reviewed from published studies. The corpus of information available was then subjected to a process of concise summarization and astute synthesis. Out of 235 studies identified for full-text review, 86 studies were included in the systematic review. The insula emerges as a brain region with a number of functional subdivisions. The semiology of insular seizures is diverse and depends on the involvement of particular subdivisions. The semiological heterogeneity of insular seizures is explained by the extensive connectivity of the insula and its subdivisions with all four lobes of the brain, deep grey matter structures, and remote brainstem areas. The mainstay of the diagnosis of seizure onset in the insula is stereoelectroencephalography (SEEG). The surgical resection of the insular epileptogenic zone (when possible) is the most effective treatment. Open surgery on the insula is challenging but magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) also holds promise. The physiological and functional roles of the insula in epilepsy have remained obfuscated. The dearth of precisely defined diagnostic and therapeutic protocols acts as an impediment to scientific advancement. This review could potentially facilitate forthcoming research endeavours by establishing a foundational framework for uniform data collection protocols, thereby enhancing the feasibility of comparing findings across future studies and promoting progress in this domain. [ABSTRACT FROM AUTHOR]

• In people having frontal lobe epilepsy surgery, combined set-of-semiology was able to correctly lateralize the epileptogenic zone in 77%. • Combined set-of-semiology was able to correctly localize the putative epileptogenic zone to subregions of the frontal lobe in 52%. • Combined set-of-semiology was superior to initial semiology alone for lateralization and localisation of the epileptogenic zone. • No association between seizure freedom and focal semiology was identified in people having frontal lobe epilepsy surgery. • Semiology must be combined with other aspects of the multimodal presurgical evaluation to reliably predict the seizure onset zone. To evaluate the ability of semiology alone in localising the epileptogenic zone (EZ) in people with frontal lobe epilepsy (FLE) who underwent resective surgery. We examined data on all individuals who had FLE surgery at our centre between January 01, 2011 and December 31, 2020. Descriptions of ictal semiology were obtained from video-EEG telemetry reports and presurgical multidisciplinary meeting summaries. The putative EZ was represented by the final site of resection. We assessed how well initial and combined set-of-semiologies correlated anatomically with the EZ, using a semiology visualisation tool to generate probabilistic cortical heatmaps of involvement in seizures. Sixty-one individuals had FLE surgery over the study period. Twelve months following surgery, 28/61 (46%) were completely seizure-free, with a further eight experiencing only auras. Comparing the semiology database with the putative EZ, combined set-of-semiology correctly lateralised in 77% (95% CI: 69–85%), localised to the frontal lobe in 57% (95% CI: 48–67%), frontal lobe subregions in 52% (95% CI: 43–62%), and frontal gyri in 25% (95% CI: 16–33%). No difference in degree of correlation was seen comparing those with ongoing seizures 12 months after surgery to those seizure free. Semiology alone was able to correctly lateralize the putative EZ in 77%, and localise to a sublobar level in approximately half of individuals who had FLE surgery. Semiology is not adequate alone and must be combined with imaging and EEG data to identify the epileptogenic zone. [ABSTRACT FROM AUTHOR]

• First paper on epilepsy diagnosis with integrated ontology and GPT model. • Ontology incorporates expert knowledge; GPT utilizes ontology to enhance diagnostics. • System validation on 16 cases; JSON Matcher improved localization accuracy to 93.8 %. • This approach can potentially spare many children from enduring years of suffering. • Demonstrates efficacy of integrating ontologies & generative AI for epilepsy management. To develop an enhanced epilepsy diagnosis system by integrating an expert-informed ontology with a custom generative pre-trained transformer (GPT), validated by inferring possible seizure lateralization and localization using retrospective textual data from the pre-surgical assessments of patients with pharmaco-resistant epilepsy (PRE). We developed an AI system for epilepsy diagnosis using Protégé with OWL/SWRL, integrating a knowledge base with seizure semiology, seizure types EEG descriptors, expert insights, and literature to pinpoint seizure locations. A customized GPT model was then tailored for specific diagnostic needs. Validated through 16 surgical cases, the system's accuracy in seizure localization and the JSON (JavaScript Object Notation) Epilepsy Matcher's term matching capabilities were confirmed against a Protégé-based knowledge base. A total of 117 patients with PRE underwent video-EEG monitoring at a single institution. However, only 16 of these patients received epilepsy surgery. The Protégé system achieved 75 % accuracy in diagnosing epilepsy from 16 cases using semiology, which increased to 87.5 % with EEG data. The Json Epilepsy Matcher further improved accuracy to 87.5 % with symptoms alone and 93.8 % when including EEG data, highlighting the benefits of applying GPT techniques. This study highlights the efficacy of the JSON Epilepsy Matcher in improving seizure diagnosis accuracy. When combined with EEG data, it achieves a 93.8 % accuracy rate, suggesting a potential improvement in the practicality and generalizability of the original ontology expert system, boosting physicians' confidence in confirming surgery and potentially sparing many children from prolonged suffering. This innovative approach not only improves diagnostic accuracy but also sets a precedent for future applications of AI in neurology. [ABSTRACT FROM AUTHOR]

This study aimed to test different AI-based face-swapping models applied to videos of epileptic seizures, with the goal of protecting patient privacy while retaining clinically useful seizure semiology. We hypothesized that specific models would show differences in semiologic fidelity compared to the original clinical videos. Three open-source models, SimSwap, MobileFaceSwap and GHOST were adopted for face-swapping. For every model, an AI generated male and female image were used to replace the original faces. One representative seizure per patient from three patients with epilepsy was chosen (3 seizure videos x 3 AI models x 2 M/F swap) and remade to 18 transformed video clips. To evaluate the performance of the three models, we used both objective (AI-based) and subjective (expert clinician) evaluation. The objective assessment included four metrics for facial appearance and four metrics for facial expression changes. Four experienced epileptologists reviewed the clips and scoring according to deidentification and preservation of semiology. Kruskal-Wallis H test was used for statistical analysis among the models. In the reproduced videos, the swapped face cannot be recognized as the original face, with no significant difference in scores of deidentification either by objective or subjective assessment. Regarding semiology preservation, no significant differences between models were observed in the objective evaluations. The subjective evaluations revealed that the GHOST model outperformed the other two models (p =0.028). This is the first study evaluating AI face swapping models in epileptic seizure video clips. Optimization of AI face-swapping models could enhance the accessibility of seizure videos for education and research while protecting patient privacy and maintaining semiology. • Deidentification and preservation of seizure semiology can be achieved by using face swapping AI models in seizure videos. • There were gaps between objective and subjective evaluation methods in transformed seizure videos. • Models with eye movement management exhibited good performance for semiologic fidelity according to clinicians' opinion. [ABSTRACT FROM AUTHOR]

Certains spécialistes de l'autisme font de l'idiotisme l'origine historique du trouble. En résonance avec cette hypothèse, l'augmentation de la prévalence du trouble du spectre autistique est expliquée par différentes hypothèses, impliquant ou non une continuité historique. L'objectif de cet article est d'explorer la validité de ces hypothèses, en nous appuyant sur une comparaison historique des descriptions cliniques de l'idiotisme et de l'autisme. Afin d'établir cette correspondance sémiologique, nous relèverons les descriptions cliniques de l'époque de l'idiotisme et les comparerons à celles de l'autisme du DSM-5. Puis, nous regarderons les autres maladies pouvant être responsables d'un retard mental et associées potentiellement à l'idiotisme. La correspondance est frappante, notamment en ce qui concerne la communication, l'absence de contact visuel, les caractéristiques psychomotrices, l'attachement aux routines, les réactions extrêmes à la sensorialité et les compétences hors-normes. Cette correspondance pourrait bien être le fruit d'un biais d'interprétation. Aujourd'hui, certaines maladies responsables du retard mental ont disparu ou leur origine biologique a été identifiée. Il apparaît que la population atteinte d'idiotisme au 19ème siècle ne correspond pas à la population observée actuellement dans l'autisme. Il se pourrait que cette correspondance soit en partie vraie, mais elle semble biaisée par l'omission de certaines maladies sorties depuis du champ psychiatrique, du fait de la découverte de leur étiologie biologique. Some autism specialists locate idiocy as the historical origin of the disorder, implying that it would be a phenomenon present throughout the ages, but only correctly diagnosed today. In resonance with this hypothesis, the increase in the prevalence of Autism Spectrum Disorder is explained by different theories. It could be linked either to an improvement in the diagnostic approach and better identification of the disorder, or to a bio-psycho-social context favoring its appearance, or to an extension of the diagnostic criteria and a modification of the classifications. The purpose of this article is to explore the validity of these different hypotheses, drawing on a historical comparison of clinical descriptions of idiocy and autism. In order to establish this semiological correspondence, we will identify the clinical descriptions from the era of idiocy written by Edouard Séguin, "l'instituteur des idiots" (the schoolmaster of idiots), and will compare them with those of the autism in the DSM-5. Then, we will look at the historical process of other diseases that may be responsible for mental retardation and potentially associated with idiocy. The overlap between idiocy and autism is striking, especially with lack of communication skills, lack of eye contact, psychomotor characteristics, attachment to routines, extreme sensory reactions, and non-standard skills. This correspondence could demonstrate the continuity of the diagnostic entity over time between idiocy and autism, but could just as well be the result of a bias in interpretation. Some diseases responsible for mental retardation observed by the alienists of Séguin's time have been identified as having a biological and genetic origin. For some of them, treatments have been found and have led to their disappearance. It appears that the population identified with idiocy in the 19th century does not correspond to the population currently diagnosed with autism. This correspondence may be partly valid, but it seems mainly biased by the omission of some diseases that have been forgotten or removed from the psychiatric field, by the fact that their biological etiology has been identified. [ABSTRACT FROM AUTHOR]

Le présent article soutient la valeur sémiologique et clinique du contact et plus particulièrement du regard. Il réinterroge en outre la place incontournable de la subjectivité dans la relation soignant-soigné. Les auteurs procèdent d'abord à l'examen du statut du regard pour les aliénistes du XIXe siècle. À l'appui de la phénoménologie et de la psychanalyse, ils interrogent ensuite celui du sentiment (Binswanger, Minkowski), du praecox Gefühl (Rümke) et finalement du vécu subjectif du praticien, au cours de l'élaboration de l'hypothèse diagnostique.. Le regard occupe une place spécifique dans les premiers temps de la rencontre clinique, notamment avec le paysage schizophrénique. Une ébauche de typologie de regards (regard décentré, regard blanc, regard extatique, regard noir) est proposée, puis nuancée. Toute tentative de délimitation des regards appelle à la déconstruction d'une classification qui se voudrait finie. Plus encore, par la résistance qu'il oppose à la mise en mots et en sens, le regard rejoint la dimension de l'angoisse, affect incontournable dans une pratique n'éjectant pas la relation. Le regard est ce lieu sans lieu, cet espace premier du contact où la relation s'initie...ou non. Au moment où se démultiplient les recherches sur les « anomalies des mouvements oculaires » dans la schizophrénie, il apparaît essentiel de renouveler notre intérêt pour la dimension relationnelle – et donc subjective – en tant que spécificité de la clinique psychiatrique. This article explores the semiological value of contact and of the gaze in clinical practices. It questions the subjectivity involved in the caregiver/patient relationship and in nosography. The authors examine the place of the gaze based on writings of 19th-century alienists. Then, they question the clinician's subjective experience–through the concepts of "sentiment" (Binswanger, Minkowski) and "praecox Gefühl" (Rümke) from the accounts of early stages of the clinical encounter. The gaze plays a specific role in the early stages of the clinical encounter, especially in the landscape of schizophrenia. A draft classification of different types of gazes (off-center gaze, white gaze, ecstatic gaze, black gaze) is proposed, then nuanced. Any attempt to classify the gaze leads to the deconstruction of any fixed typology. The gaze resists verbalization and even meaning, and in this, belongs to the dimension of anguish, an essential affect in a practice that does not seek to do away with relationship. At a time of increasing research in "eye movement abnormalities" in schizophrenia, it seems essential to renew our interest in the relational and therefore subjective–dimension as a specificity in clinical psychiatry. The gaze, then, would be this area without a place, this primary area of contact where relationship begins... or not. [ABSTRACT FROM AUTHOR]

Empêtré dans une sémiologie qu'elle veut raccorder à la sémiologie médicale, la psychiatrie ne prend pas assez en considération la question du « discours intérieur » alors que de nombreux phénomènes psychiatriques procèdent de l'articulation entre ce discours intérieur et le discours dit « extérieur ». L'intention de cet article est d'attirer l'attention de la psychiatrie sur cette question du discours intérieur, insuffisamment abordée et analysée par la psychiatrie. La sémiologie proprement psychiatrique devrait s'intéresser d'avantage à cette problématique du discours intérieur. Pour cela, elle pourrait intégrer l'apport de la linguistique moderne, mais aussi redécouvrir et (ré) investir la théorie du langage de Jacques Lacan. L'article rappelle d'abord les principes de base de la sémiologie psychiatrique en se basant sur les travaux de Lantéri-Laura, Henri Ey et plus récemment ceux de Steeves Demazeux. Il montre comment la psychiatrie est passée d'une sémiologie « classique » fondée sur le corps à celle des facultés mentales, et souligne que la question du discours intérieur ne trouve pas sa place dans ces approches. Dès lors, il est intéressant de se tourner vers certains linguistes et la théorie du langage de Lacan, de façon à aborder différemment la question des hallucinations et de l'automatisme mental. Hallucinations, délires, ruminations obsessionnelles et mélancoliques...Tous ces phénomènes sont en rapport avec la question du discours intérieur. Ce qui ne veut pas dire qu'ils sont similaires ou doivent être abordés de manière comparable. L'être humain semble à la fois parlant par le discours extérieur et parlé en partie par le discours intérieur. Il faut en tenir compte non seulement d'un point de vue sémiologique mais aussi lorsqu'il s'agit d'organiser les soins. Entangled in a semiology that aspires to imitate medical semiology, psychiatry does not take seriously enough the question of internal discourse, while many psychiatric phenomena relate to the articulation between internal discourse and external discourse. The intention of this article is to draw the attention of psychiatry to the issue of internal discourse, which is insufficiently addressed within the discipline. Psychiatric semiology should be more interested in and should approach this issue of internal discourse differently. For this, it could integrate the contribution of modern linguistics and rediscover Jacques Lacan's theory of language. The article first recalls the basic principles of psychiatric semiology based on the work of Lanteri-Laura, Henri Ey, and, more recently, that of Steeves Demazeux. He shows how psychiatry has moved from a classical semiology based on the body to that of mental faculties, more or less attached to bodies. The question of internal discourse does not find its place in these approaches. Hallucinations, delusions, obsessive and melancholy ruminations... All these phenomena are related to the question of inner speech. This does not mean that they are similar or should be approached in a comparable way. Human beings seem to be both speaking through their outwardly directed speech and partly spoken, through their internal speech. This must be taken into account not only from a semiological point of view but also when it comes to organizing care. [ABSTRACT FROM AUTHOR]

Rendre compte de la construction, par G. Lantéri–Laura, philosophe et historien de la psychiatrie, d'une phénoménologie de la psychiatrie vouée à l'élucidation critique de ses fondements, indissociable de l'approche concrète de son histoire, appréhendée avec les méthodes du structuralisme. Les étapes en sont résumées et référées au parcours de leur auteur, non sans rendre hommage à sa personne et à son œuvre. Cette phénoménologie du fait psychiatrique privilégie l'étude du signe , de ses effets de sens, et requiert la clarification des conditions de sa production, dont le savoir et le savoir-faire qu'elle suppose. Prolongeant les travaux d'E. Minkowski grâce aux principes du structuralisme, G. Lantéri–Laura considère la structure de la sémiotique de la psychiatrie et effectue de nombreux apports à sa sémiologie, notamment du langage. Tenant l'investigation de sa praxis pour inséparable de son histoire, il en forge une périodisation en divers paradigmes, conforme à l'épistémologie de Th. Kuhn et à la conception de l'histoire de Cl. Lévi–Strauss. Il noue à cette phénoménologie une approche de la subjectivité qui conserve le vœu d'évidence de Husserl, mais sans rejeter l'inconscient, en se gardant de la tendance hégémonique et totalisante de toute psychopathologie par l'élucidation rigoureuse de la sémiotique de la psychiatrie et l'accent mis sur les caractères régional, pluriel et historique de son épistémologie. G. Lantéri–Laura a proposé une épistémologie phénoménologique de la psychiatrie, inséparable des trois dimensions de la sémiotique, de la subjectivité et de son histoire. The article aims to give an account of the construction, by G. Lantéri–Laura, philosopher and historian of psychiatry, of a phenomenology of psychiatry dedicated to the critical elucidation of its foundations, inseparable from the concrete approach of its history, apprehended with the methods of structuralism. The stages of this construction are summarized and connected to the path of their author, while paying tribute to him and his work. This phenomenology of the psychiatric fact privileges the study of the sign and its effects of meaning, and requires the clarification of the conditions of its production, including the knowledge and the know-how that it supposes. Extending the work of E. Minkowski thanks to the principles of structuralism, G. Lantéri–Laura considers the structure of the semiotics of psychiatry and makes numerous contributions to its semiology, notably of language. Considering the investigation of its praxis to be inseparable from its history, he forges a periodization of it in various paradigms, in conformity with T. Kuhn's epistemology and with C. Lévi–Strauss's conception of history. Lantéri–Laura links this phenomenology with an approach to subjectivity that keeps Husserl's vow of evidence, but without rejecting the unconscious, thus resisting the hegemonic and totalizing tendency of any psychopathology through the rigorous elucidation of the semiotics of psychiatry and the emphasis put on the regional, plural, and historical characters of its epistemology. G. Lantéri–Laura has proposed a phenomenological epistemology of psychiatry, inseparable from the three dimensions of semiotics, subjectivity, and its history. [ABSTRACT FROM AUTHOR]

Purpose: Myelin oligodendrocyte glycoprotein (MOG) antibodies (Abs) are associated with various central nervous system demyelinating disorders. Recently, they were detected in cerebral cortical encephalitis (CCE), which often causes seizures. We performed a literature review to elucidate the electroclinical features of CCE. In addition to the published cases, we describe a new, illustrative case of MOG-Ab-associated CCE (MOG-CCE) with multifocal seizures documented by video electroencephalograph (EEG).Methods: We searched PubMed with the keywords "[MOG] AND [encephalitis]" and reviewed relevant articles. The articles included reports of patients with CCE (as demonstrated by magnetic resonance imaging) and serum MOG Ab positivity. Cases were excluded if no epileptic seizures were reported or if details of the seizures were unavailable.Results: Our literature review identified 34 patients with MOG-CCE. An analysis of these 34 cases and the new case showed that 20 patients were male (57.1%), and the median age at presentation was 23 years (range, 6 to 46 years). Focal to bilateral tonic-clonic seizure was the most common seizure type, followed by focal motor seizure in the face or an arm or leg. EEG findings were available for 26 patients. Interictal epileptiform discharges (IEDs) and ictal EEG patterns were seen in 10 (38.5%) and 5 (19.2%) patients, respectively. Focal EEG abnormalities, including slow waves and IEDs, were observed in the central, parietal, occipital, or posterior temporal region.Conclusion: MOG-CCE has distinctive electroclinical features that differ from those of other autoimmune encephalitides. Careful electroclinical analysis of seizures can be helpful for diagnosing MOG-CCE. [ABSTRACT FROM AUTHOR]

Le recueil des données d'anamnèse est fondamental en allergologie notamment en cas de suspicion d'allergie au venin d'hyménoptère. Les différents symptômes cliniques et leur chronologie doivent systématiquement être colligés dans les dossiers médicaux. Que ce soit une réaction loco-régionale, une réaction systémique anaphylactique ou une atteinte d'organe, l'attitude thérapeutique ultérieure sera différente. Ce sont ces éléments sémiologiques qui permettent de décider ou non de l'indication ou non d'une immunothérapie et des médicaments d'urgence à mettre en place. The collection of anamnesis data is fundamental in allergology, especially in cases of suspected allergy to hymenoptera venom. The various clinical symptoms and their chronology must be systematically collected in the medical files. Whether there is a locoregional reaction, a systemic anaphylactic reaction or organ damage, the subsequent therapeutic attitude will be different. These semiological elements make it possible to decide whether or not an immunotherapy is indicated and whether emergency medications should be prescribed. [ABSTRACT FROM AUTHOR]

Objectives: To identify semiologic features of automatisms correlating to different seizure onset zones (SOZ).Methods: In total, 204 seizures from 74 patients with either oral or manual automatisms were assessed. Patients were divided into four groups depending on the SOZ into frontal, posterior, neocortical temporal, and mesial temporal cortex groups. A k-means analysis was applied on 11 semiologic features on a multi-criteria scale. Then, the resulting clinical patterns were correlated with the SOZs determined by presurgical anatomy-electroclinical data (25 cases with stereo-EEG).Results: Four clinical patterns of automatisms with different accompanying symptoms were identified. The clinical features of clusters 1 and 4 were mostly found in temporal epilepsy whereas clusters 2 and 3 were more frequent in extratemporal epilepsy. Cluster 1 was significantly correlated with mesial temporal lobe epilepsy (p = .017) and was characterised by aura, postictal confusion, short automatisms delay. Cluster 3 included 1/3 patients with frontal lobe epilepsy and was characterised by emotionality. Cluster 4 was related to neocortical temporal lobe epilepsy and characterised by dystonia and short automatism delay (p = .011).Conclusion: The distinct semiologic patterns of automatisms may provide information which may allow clinicians to define the SOZs. These findings could improve diagnostic accuracy and surgical outcome. [ABSTRACT FROM AUTHOR]

Clinical seizure signs continue to be of central importance to guide diagnosis, classification, treatment and prognosis. Some basic principles guide history-taking and observation in clinical epileptology. The information contained within subjective seizure descriptions can be framed within standardized vocabulary and a classification of ictal signs, seizure types, and the integrated framework of epilepsy syndromes. As illustrative examples, we discuss the historical origins and current research context of Dravet syndrome and Janz syndrome, two genetic epilepsy syndromes. In candidates for epilepsy surgery, ictal signs aid us in identifying the symptomatogenic zone and hence delineating the ictal onset zone. Here, historical reports from Victor Horsley and Hughlings Jackson provide valuable perspective on clinical reasoning. Lastly, the information contained within clinical signs and syndromes presents an indispensable data source in future efforts of large-scale genotype-phenotype correlations and machine learning methods. [ABSTRACT FROM AUTHOR]

L'approche phénoménologique peut être un outil de travail complémentaire à une approche psychiatrique classique ainsi qu'à une approche neuro-biologique dans le repérage des symptômes précurseurs de l'entrée d'un sujet dans le spectre de la schizophrénie. Nous présentons le cas clinique d'Ellen et proposons une analyse psychopathologique de sa symptomatologie à l'aide du modèle « ipseity, hyperreflexivity », élaboré par L. Sass et par J. Parnass, tout en nous appuyant — entre autres, pour étudier le vécu corporel — sur les travaux de M. Merleau-Ponty et de G. Stanghellini. La phénoménologie apprend à analyser l'épaisseur des vécus d'un sujet en tant qu'expression de la modalité de son être-au-monde. Cette approche psychopathologique, centrée sur la rencontre avec des formes d'existence, permet de saisir les premières déformations de l'expérience subjective, qui sont l'indice d'une vulnérabilité psychotique, avant la constitution de symptômes psychiatriques avérés. Dans le cas d'Ellen, nous essayons d'élucider l'expérience des altérations du vécu du corps propre et de montrer que la phénoménologie enseigne à utiliser l'observation clinique comme un travail de reconstruction du sens ce qui est d'emblée un geste psychothérapeutique. Les anomalies de l'expérience subjective, que la phénoménologie permet de saisir avec une finesse sémiologique, pourraient se révéler un levier pour développer la recherche dans ce domaine de la santé mentale et de réhabiliter le corps dans la clinique psychiatrique. La psychopathologie phénoménologique suggère des perspectives de recherche novatrices dans le domaine de la santé mentale et dans la compréhension de la schizophrénie. The phenomenological approach may be used as a complementary tool, alongside a traditional psychiatric approach and a neurobiological approach, in order to identify the symptoms that precede schizophrenia. Ellen's clinical case will be presented. Her symptomatology will be analyzed following the "ipseity, hyperreflexivity" model, as elaborated by L. Sass and J. Parnass. M. Merleau-Ponty's and G. Stanghellini's works will also be used, inter alia , to study Ellen's bodily experience. Phenomenology analyzes the depth of a subject's life experience as the expression of his/her Dasein or "existence". Through this psychopathological approach, focused on meeting other forms of existence, one can comprehend the first deformations of subjective experience; these indicate a vulnerability to psychosis that may precede actual psychiatric symptoms. This paper aims at explaining the alterations of Ellen's bodily experience, and at showing that phenomenology teaches how to use clinical observation as a reconstructive work of meaning – which is, already, a psychotherapeutic act. The anomalies of subjective experience, which can be semiologically comprehended through a phenomenological approach, might prove to be a stimulus for the development of mental health research, as well as for the rehabilitation of the body in psychiatric care. Phenomenological psychopathology opens up new research opportunities in the field of mental health and in the understanding of schizophrenia. [ABSTRACT FROM AUTHOR]

Rhythmic body rocking movements may occur in prefrontal epileptic seizures. Here, we compare quantified time-evolving frequency of stereotyped rocking with signal analysis of intracerebral electroencephalographic data. In a single patient, prefrontal seizures with rhythmic anteroposterior body rocking recorded on stereoelectroencephalography (SEEG) were analyzed using fast Fourier transform, time-frequency decomposition and phase amplitude coupling, with regards to quantified video data. Comparison was made with seizures without rocking in the same patient, as well as resting state data. Rocking movements in the delta (∼1 Hz) range began a few seconds after SEEG onset of low voltage fast discharge. During rocking movements: (1) presence of a peak of delta band activity was visible in bipolar montage, with maximal power in epileptogenic zone and corresponding to mean rocking frequency; (2) correlation, using phase amplitude coupling, was shown between the phase of this delta activity and high-gamma power in the epileptogenic zone and the anterior cingulate region. Here, delta range rhythmic body rocking was associated with cortical delta oscillatory activity and phase-coupled high-gamma energy. These results suggest a neural signature during expression of motor semiology incorporating both temporal features associated with rhythmic movements and spatial features of seizure discharge. [ABSTRACT FROM AUTHOR]

Purpose: Ictal blinking may be observed in various forms of epilepsies. In the context of presurgical assessment of drug-resistant focal epilepsies, its semiological value is poorly understood. Our aims were to determine the prevalence and localizing value of ictal blinking.Methods: We reviewed our cohort of more than 300 patients explored by SEEG, searching for ictal blinking. We defined seizure onset zone (SOZ) using visual analysis complemented by a quantified method (epileptogenicity index). We analysed the features of ictal blinking and the associated signs. We tested for statistically significant associations with the underlying SOZ.Results: We found that about 8% of our patients exhibited ictal blinking, mostly bilateral. Ictal blinking was seen mostly in four types of SOZ: occipital, occipito-temporal, temporal mesial, and insulo-opercular. It was significantly over-represented in occipito-temporal and occipital SOZ. Eye blinking was fastest in insulo-opercular SOZ and slowest in temporal mesial SOZ. Nystagmus and tonic eye deviation were associated with SOZ involving the occipital lobe.Conclusion: Ictal blinking is not uncommon in the population of patients with drug-resistant focal epilepsies. It is mostly associated with four types of SOZ: occipital, occipito-temporal, temporal mesial, and insulo-opercular. Some features of ictal blinking, as well as the analysis of the associated signs, allow to orient clinical hypotheses toward some specific SOZ. [ABSTRACT FROM AUTHOR]

• Semiology of electrically induced and spontaneous seizures was compared. • High similarity was associated with favorable postsurgical seizure outcome. • Induced seizures may contribute to predict postsurgical seizure freedom. To determine whether semiological similarity of electrically induced seizures (EIS) and spontaneously occurring habitual seizures (SHS) is associated with postsurgical seizure outcome in patients undergoing invasive video-EEG monitoring (VEM) before resective epilepsy surgery. Data of patients undergoing invasive VEM were retrospectively reviewed and included if at least one EIS and SHS during VEM occurred and the brain region in which EIS were elicited was resected. Seizure outcome was evaluated at three follow-up (FU) visits after surgery (1, 2 years and last available FU) according to the classification by Engel and the International League Against Epilepsy (ILAE). The level of semiological similarity of EIS and SHS was rated blinded to the surgical outcome. Statistics were done using Fisher's exact test and a mixed linear-logistic regression model. 65 patients were included. Postsurgical seizure freedom was achieved in 51% (ILAE class 1) and 58% (Engel class I) at last FU (median 36 months). Patients with identical EIS and SHS displayed significantly better postsurgical seizure outcomes (ILAE class 1 at last FU: 76% vs. 31%, p < 0.001; Engel class I: 83% vs. 39%, p < 0.001). EIS are useful to confirm the location of the epileptogenic zone. A high level of similarity between EIS and SHS is associated with a favorable postsurgical seizure outcome. EIS may be used as an additional predictor of postsurgical outcome when counselling patients to proceed to resective epilepsy surgery. [ABSTRACT FROM AUTHOR]

La maladie d'Alzheimer, la schizophrénie, l'autisme... sont classiquement des maladies affectant principalement la personne dans leur être-avec et l'être-au-monde. Elles altèrent progressivement de nombreux processus cognitifs et affectifs, en premier lieu la mémoire, mais aussi le jugement et le langage. Leurs interactions conduisent à une perte d'emprise du malade sur son environnement matériel et sur sa capacité de vie relationnelle. Le patient trouve parfois des substitutions pour pallier ses difficultés. L'un de ceux-ci est un outil sémiotique, l'analogon, dont le fonctionnement est décrit dans cet article. Il permet de retrouver un sens, une identité et une inscription dans un monde où le malade retrouve du bien-être. L'être humain ne fonctionne pas uniquement de façon digitale. Il résonne aussi de façon analogique, en particulier dans des segments importants qui mobilisent les affects, l'esthétique, la prise en compte empathique d'autrui. L'analogon est un objet identifiant qui permet de contourner les impossibilités cognitives, assurant une reprise de pratiques marquées par des stratégies personnelles antérieures, et rendant efficiente une pensée de secours. Il constitue, lorsqu'il est accepté par les soignants, un outil thérapeutique particulièrement bien adapté au malade dément. Utilisé dans la pratique sociale quotidienne pour des personnes sans troubles cognitifs, il permet de plus de comprendre et de répondre à certaines angoisses qui se traduisent autrement sous un mode violent. Alzheimer's disease, schizophrenia, autism are classically diseases that primarily affect the person in their being-with and being-in-the-world. It progressively alters many cognitive processes, primarily memory, but also judgment and language. Their interactions lead to a loss of the patients's coping on his material environment and on their capacity for interpersonal life. The patients sometimes find substitutions to overcome their difficulties. One of these is a semiotic tool, the analogon, whose operation is described in this article. It allows them to find a sense, an identity and an inscription to the world where they find a well-being. The human being does not work only digitally. It also resonates analogically especially in important segments that mobilize the affects, aesthetics, empathic consideration of others. The analogon is an identifying object that makes it possible to circumvent cognitive impossibilities, ensuring a recovery of previous personal strategy practices, and making effective a relief thought. When accepted by caregivers, analogon constitutes a therapeutic tool, particularly well adapted to the demented patient. Used in everyday social practice for people without cognitive impairment, it also allows to understand and respond to certain anxieties that are translated into a violent mode. [ABSTRACT FROM AUTHOR]

Background: Ictal and postictal testing carried out in long-term epilepsy monitoring units is often sub-optimal. Recently, a European consensus protocol for testing patients during and after seizures was developed by a joint taskforce of the International League Against Epilepsy - Commission on European Affairs and the European Epilepsy Monitoring Unit Association.Aim: Using this recently developed standardised assessment battery as a framework, the goal of this narrative review is to outline the proposed testing procedure in detail and explain the rationale for each individual component, focusing on the underlying neurobiology. This is intended to serve as an educational resource for staff working in epilepsy monitoring units.Methods: A literature review of PubMed was performed; using the search terms "seizure", "ictal", "postictal", "testing", "examination", and "interview". Relevant literature was reviewed and relevant references were chosen. The work is presented as a narrative review.Results: The proposed standardised assessment battery provides a comprehensive and user-friendly format for ictal-postictal testing, and examines consciousness, language, motor, sensory, and visual function.Conclusion: The standardised approach proposed has the potential to make full use of data recorded during video EEG increasing the diagnostic yield with regards to lateralisation and localisation, aiding both presurgical and diagnostic studies. [ABSTRACT FROM AUTHOR]

This paper offers a new avenue in contemplating semiology beyond linguistics: it introduces accounting as ' Financial Semiology '. The paper discusses the implications of a semiological theorisation of accounting, particularly in problematising the conventional assumptions underlying two important accounting issues: recognition and measurement of the firm's assets, specifically with respect to the notion of alleged 'representation' of assets and their seemingly 'intrinsic value'. Through two core pillars in Saussure's semiology, re-titled here as 'reciprocal articulation' and 'value constellation', the paper offers an alternative theorisation of such accounting procedures. The paper also shows the implications of such Financial Semiology for the general theory of semiology, and distils its core characteristics as a framework for explicating the non-substantive operation of social sign systems. • Accounting is the one truly extra-linguistic semiology: a Financial Semiology. • Instead of 'representation', accounting manifests semiology's 'articulation'. • Instead of intrinsic value, accounting manifests semiology's 'value constellation'. • Accounting explicates the non-substantive operation of semiological systems. [ABSTRACT FROM AUTHOR]

De nos jours, la notion de violence occupe une place de plus en plus grande dans le champ psychiatrique et psychopathologique qui mérite d'être interrogée. D'abord repérée comme un « comportement violent » se prêtant à une analyse psychanalytique, la violence a été un objet d'étude psychopathologique aux frontières de la criminalité et de la psychopathologie, pour devenir une quasi-entité clinique avec la notion de « patient violent », dont la dangerosité doit être évaluée, qui fait suite à celle de « malade difficile ». L'étude des développements des travaux psychanalytiques sur la psychopathologie de l'agir redonnent une dynamique psychique et un sens au passage à l'acte devenu une modalité d'expression de la souffrance psychique en devenant un passage par l'acte porté par des processus psychiques complexes. L'extension de la notion de « patient violent » abrase les riches notions sémiologiques issues de l'observation psychiatrique classique. L'agitation, la fureur, le raptus, l'état confusionnel, ou l'accès aigu d'angoisse peuvent gagner à être relus avec l'éclairage psychopathologique actuel et permettre de rétablir une pensée clinique organisatrice des pratiques de soins. La réponse institutionnelle, qui contraint les corps et isole de la société, souligne, en négatif, que la clinique de la violence est avant tout une clinique du corps et de la rencontre intersubjective marquée par des angoisses massives. C'est en redonnant une place au corps et à l'acte dans l'expression de « terreurs agonistiques » que l'on peut retrouver une sémiologie clinique faisant sortir la violence d'une vision unique et menaçante. Today, the notion of violence occupies an increasingly large place in the psychiatric and psychopathological field, which deserves to be explored. First identified as "violent behavior" amenable to psychoanalytic analysis, violence has been an object of psychopathological study on the boundaries between crime and psychopathology, to become a quasi clinical entity with the notion of the "violent patient" whose dangerousness must be evaluated, following on from that of the "difficult patient". The study of developments in psychoanalytic work and the psychopathology of action give a psychic dynamic and a meaning to acting out, which becomes a mode of expression of psychic suffering, an acting out mobilised by complex psychic processes. The extension of the notion of the "violent patient" goes against the rich semiological notions derived from classic psychiatric observation. The agitation, the fury, the raptus, the confusional state, or the acute attack of anguish can be usefully reread in the light of current psychopathological trends, and this can make it possible to reestablish a clinical view of the organization of care practices. The institutional response, which constrains bodies and isolates them from society, puts negative emphasis on the fact that the clinical approach to violence is above all a clinical approach to the body and an intersubjective encounter entailing massive anxieties. It is by giving back a place to the body and to the act in the expression of "agonistic terrors" that we can find a clinical semiology that brings violence out of a solely threatening perspective. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the frequency of dramatic presentations of psychogenic nonepileptic seizures (PNES) (i.e., urine incontinence and ictal injury) and to characterize the patients' historical risk factors that may be associated with such dramatic manifestations.Methods: In this retrospective database study, all patients with PNES, who were investigated at Shiraz Comprehensive Epilepsy Center at Shiraz University of Medical Sciences, from 2008 until 2018, were studied.Results: 259 patients with PNES-only were studied. Thirty-one patients (12%) reported experiencing urinary incontinence. Seventy-five patients (29%) reported having a bodily injury. The associated injuries were as follows: lacerations (35; 13.5%), tongue biting (32; 12%), fractures (5; 2%), burns (2; 1%), and dental injuries (1; 0.5%). Fifty-seven (67%) patients with one of these features and 91 patients (53%) without any of these features were taking antiepileptic drugs; the difference was significant (p = 0.03).Conclusion: Patients with PNES may frequently present with dramatic features including, ictal injury or urinary incontinence, and as a result are at great risk of receiving wrong diagnosis and unnecessary treatments. [ABSTRACT FROM AUTHOR]

Purpose: The recent explosion of artificial intelligence techniques in video analytics has highlighted the clinical relevance in capturing and quantifying semiology during epileptic seizures; however, we lack an automated anomaly identification system for aberrant behaviors. In this paper, we describe a novel system that is trained with known clinical manifestations from patients with mesial temporal and extra-temporal lobe epilepsy and presents aberrant semiology to physicians.Methods: We propose a simple end-to-end-architecture based on convolutional and recurrent neural networks to extract spatiotemporal representations and to create motion capture libraries from 119 seizures of 28 patients. The cosine similarity distance between a test representation and the libraries from five aberrant seizures separate to the main dataset is subsequently used to identify test seizures with unusual patterns that do not conform to known behavior.Results: Cross-validation evaluations are performed to validate the quantification of motion features and to demonstrate the robustness of the motion capture libraries for identifying epilepsy types. The system to identify unusual epileptic seizures successfully detects out of the five seizures categorized as aberrant cases.Conclusions: The proposed approach is capable of modeling clinical manifestations of known behaviors in natural clinical settings, and effectively identify aberrant seizures using a simple strategy based on motion capture libraries of spatiotemporal representations and similarities between hidden states. Detecting anomalies is essential to alert clinicians to the occurrence of unusual events, and we show how this can be achieved using pre-learned database of semiology stored in health records. [ABSTRACT FROM AUTHOR]

Résumé Cet article revisite la notion de bouffée délirante aiguë introduite par Valentin Magnan ainsi que les principaux développements ayant trait à cette entité nosographique spécifiquement française. Les traits et la trace de cette entité clinique sont d'abord repérés dans le champ de la psychiatrie classique puis dans le champ de la sémiologie contemporaine francaise et internationale. Dans un deuxième temps, cet article propose une lecture de la bouffée délirante aiguë au regard du sentiment d'inquiétante étrangeté et de ses destins. L'émergence des manifestations de l'ordre de l'inquiétante étrangeté est consubstantielle de la survenue des changements subjectifs. Sous ce prisme, la bouffée délirante est examinée en tant qu'expression paradigmatique, mais non exclusive du processus adolescent et comme étant au principe d'un moment de désymbolisation-resymbolisation des processus inconscients de la pensée. Abstract This article revisits the concept of "bouffée délirante" ("delirious flash" or "acute delirious puff") introduced in 1886 by Valentin Magnan, as well as the main developments of this specifically French nosographic entity. The features and the trace of this clinical entity are first identified in the field of classical psychiatry and then in the field of contemporary semiology, both French and international. In a second step, this article proposes a reading of the acute delirious puff with regard to the feeling of the uncanny and its destinies. The emergence of manifestations of the uncanny is consubstantial with the occurrence of subjective changes. Under this prism, the delirious whiff is examined as a paradigmatic but not exclusive expression of the adolescent process, as well as at the beginning of a moment of disymbolisation-resymbolisation of the unconscious processes of thought. [ABSTRACT FROM AUTHOR]

Highlights • Frequent semiological signs in frontal lobe epilepsy include unilateral motor signs. • In infancy, myoclonic movements with unclear lateralizing value are more frequent. • Lateralizing motor signs become more common with increasing age. • Age-dependent alterations in phenomenology may reflect maturation in connectivity. Abstract Introduction Frontal lobe epilepsy is the second most frequent origin of focal epilepsy. Various studies have discussed localizing aspects of ictal signs in frontal lobe epilepsy; the effect of age on semiological manifestations has, however, not been analyzed so far. Material and methods We retrospectively analyzed video-documented semiological signs in a cohort of 122 consecutive patients aged 0–70 years (mean age: 24.9 years) with EEG/MR evidence for frontal lobe epilepsy undergoing video-EEG telemetry assessment between 1999 und 2016. Results In this patient cohort, most common etiologies were focal cortical dysplasia (48%) and tumors (16%). Most frequent ictal manifestations overall were impaired language comprehension (60.3%), unilateral tonic posturing (58.9%), unilateral cloni (46.6%), versive movements (44.5%), vocalization (42.5%) and impaired reactivity to non-verbal stimuli (40.4%). With increasing age, sign of four (p = 0.019), dystonic posturing (p = 0.026), changes in heart rate (p = 0.014) and impaired reactivity to non-verbal stimuli (p = 0.009) occurred significantly more frequently. In contrast, myoclonic components were significantly less frequent observed in the higher age group (p = 0.037). Conclusions Frontal lobe seizures can be categorized into different behavioral manifestations related to involved symptomatic brain regions, including clonic, bilateral asymmetric tonic seizures and complex motor phenomena. In this cross-sectional study, we found age-related changes in the frequency of both, motor and non-motor semiological elements. Especially simple lateralized motor signs like dystonic posturing, sign of four and version were more common with increasing age. Age-dependent alterations in phenomenology may reflect maturation in connectivity and seizure propagation within and beyond the frontal lobe, and affect the localizing and lateralizing value of ictal phenomena. [ABSTRACT FROM AUTHOR]

Résumé L'approche systématique et l'examen clinique des patients constituent des piliers centraux pour l'enseignement de la médecine. Cependant, très peu d'étudiants en médecine apprennent à examiner un patient souffrant de troubles psychiatriques au cours de leur parcours. Nous proposons dans cet article la réflexion didactique qui a permis le développement d'un guide pour un examen clinique psychiatrique standardisé à destination des étudiants en médecine. Ce guide a été construit à partir de la trame d'un examen médical classique (antécédents, histoire de la maladie, biographie, etc.). Il incorpore également les différents domaines et étapes du Mental Status Examination (MSE) ainsi que des questions issues de plusieurs outils standardisés. Le document proposé se veut simple et facile à utiliser (système de cases à cocher) afin de faciliter les premiers entretiens des étudiants en médecine et des jeunes internes. La maîtrise de l'examen clinique est une étape essentielle dans le processus d'apprentissage de la médecine qui permettra ensuite d'intégrer, avec l'expérience, la souplesse et l'adaptabilité nécessaire à tout entretien psychiatrique. Abstract The systematic approach and the examination of patients are central for the teaching of medicine. However, a very large proportion of medical students are not taught to examine patients with psychiatric disorders. This article summarizes the didactic reflection behind the development of a guide for medical observation in psychiatry for medical students. This guide was built from the framework of a classic medical examination (history of illness, biography, etc.). It also incorporates the different steps from the Mental Status Examination (MSE) as well as questions from several standardized tools. This guide document is intended to be simple and easy to use (check box system) to facilitate the interviews of medical students and residents in psychiatry. Master the clinical examination is an essential step in the process of learning medicine that will then allow to integrate, with experience, the flexibility and adaptability necessary for a psychiatric interview. [ABSTRACT FROM AUTHOR]

Résumé L'analyse sémiologique de l'hallucination peut être enrichie d'une approche dimensionnelle, qui permet notamment d'explorer ce phénomène de manière transnosographique. Dans le cas de l'hallucination acousticoverbale, trois dimensions sont communément utilisées : (i) le « quoi », qui définit la complexité sensorielle de l'hallucination ; (ii) le « qui », qui correspond à l'identité du locuteur mais également l'attribution à soi ou à autrui de ces stimuli ; et enfin (iii) le « where », qui renvoie à la localisation spatiale des voix perçues. Actuellement, l'imagerie fonctionnelle permet d'associer des signaux cérébraux spécifiques à certaines de ces caractéristiques phénoménologiques, telles que la modalité sensorielle décrite, le caractère intrusif de l'hallucination ou encore la perception de l'hallucination comme intrapsychique ou au contraire spatialisée. Une caractérisation clinique fine de ces expériences peut par ailleurs permettre de guider certains traitements psychiatriques, tels que la neuromodulation (rTMS, tDCS), grâce à des outils de neuronavigation. En effet, des cibles de stimulation transcrânienne noninvasive peuvent être repérées précisément et pour chaque individu sur la base des données cliniques et des données de l'imagerie fonctionnelle de capture hallucinatoire propre au sujet. Ainsi l'exploration fine de la phénoménologie et de la sémiologie hallucinatoire est en mesure, aujourd'hui, de nous aider à mieux traiter nos patients et à les soulager de symptômes envahissants et parfois pharmacorésistants. Abstract The semiological exploration of hallucinations can be enriched by a dimensional approach, which helps to explore these experiences trans-nosographically. In the case of acoustic-verbal hallucinations, three clinical dimensions have been described: the "what", which defines the sensory complexity of hallucinatory experiences ; the "who", which refers to the speaker's identity but also to self-other (mis)attribution ; and finally the "where", which refers to the spatial location of the voices. Functional brain imaging can associate specific neural signals or networks with these phenomenological features, such as the sensory modality involved in the experience, the intrusiveness of hallucinations or the intrapsychic/spatialized nature of the voices. A precise clinical characterization of hallucinatory experiences can be used to guide psychiatric treatments, such as noninvasive brain stimulations, using neuronavigation tools. Indeed, individual cortical targets can be precisely identified combining clinical data with hallucinations' capture functional imaging data. Overall the subtle exploration of hallucinations' phenomenology and semiology is now able to guide clinicians in providing better care and relieve invasive and potential drug-resistant symptoms. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the frequency, localizing significance, and intensity characteristics of ictal vocalization in different focal epilepsy syndromes.Methods: Up to four consecutive focal seizures were evaluated in 277 patients with lesional focal epilepsy, excluding isolated auras and subclinical EEG seizure patterns. Vocalization was considered to be present if observed in at least one of the analyzed seizures and not being of speech quality. Intensity features of ictal vocalization were analyzed in a subsample of 17 patients with temporal and 19 with extratemporal epilepsy syndrome.Results: Ictal vocalization was observed in 37% of the patients (102/277) with similar frequency amongst different focal epilepsy syndromes. Localizing significance was found for its co-occurrence with ictal automatisms, which identified patients with temporal seizure onset with a sensitivity of 92% and specificity of 70%. Quantitative analysis of vocalization intensity allowed to distinguish seizures of frontal from temporal lobe origin based on the intensity range (p = 0.0003), intensity variation (p < 0.0001), as well as the intensity increase rate at the beginning of the vocalization (p = 0.003), which were significantly higher in frontal lobe seizures. No significant difference was found for mean intensity and mean vocalization duration.Conclusions: Although ictal vocalization is similarly common in different focal epilepsies, it shows localizing significance when taken into account the co-occurring seizure semiology. It especially increases the localizing value of automatisms, predicting a temporal seizure onset with a sensitivity of 92% and specificity of 70%. Quantitative parameters of the intensity dynamic objectively distinguished frontal lobe seizures, establishing an observer independent tool for semiological seizure evaluation. [ABSTRACT FROM AUTHOR]

Purpose: Generalized seizures were often thought to be contraindications for hemispherectomy. However, few studies had investigated this issue comprehensively, as well as the predictors for generalized seizures in hemispheric lesion. We studied the predictors of generalized seizures and their potential link to seizure outcomes in a cohort of children who underwent hemispherectomy.Methods: A cohort of 76 children with hemispherectomy were reviewed and dichotomized into two groups with and without generalized seizures confirmed by vEEG presurgically. All preoperative evaluation data correlated to generalized seizures and postoperative prognosis were collected and analysed.Results: Of 76 patients, 11 (14.5%) cases were documented with various generalized seizures, including atypical absence (54.5%, 6/11), myoclonic (45.5%, 5/11), atonic (36.4%, 4/11), myoclonic-atonic (18.2%, 2/11), myoclonic-absence (9.1%, 1/11) and spasms (9.1%). Electrical status epilepticus during sleep (ESES) was recorded in 3 patients (27.3%, 3/11). At last follow-up, 72.7% (8/11) patients remained seizure-free. ESES was a predictor of generalized seizures (χ2 = 4.69, P = 0.043). No correlation was found between generalized seizures and unfavourable postoperative seizure outcome (P = 0.153). For different seizure types, focal to bilateral tonic-clonic seizures (P = 0.020) and myoclonic-atonic seizures (P = 0.002) might correlate with unfavourable outcomes.Conclusion: Generalized seizures were not an absolute contraindication for hemispherectomy. Those patients with ESES might experience generalized seizures presurgically. Focal to bilateral tonic-clonic seizures and myoclonic-atonic seizures pre-surgery may indicate unfavourable post-operative seizure outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate if psychiatrists could predict the diagnosis of psychogenic nonepileptic seizures (PNES) by reviewing videos of seizures of various types and to compare the accuracy and the criteria leading to the diagnosis used by psychiatrists with those used by epileptologists.Methods: Four board-certified psychiatrists were asked to review 23 videos capturing representative events of 21 unselected consecutive patients admitted to an epilepsy center for long-term video-EEG monitoring. All raters were blind to EEG and clinical information. They were requested to (1) rate the videos for quality and content; (2) choose among four diagnoses: (a) epileptic seizures; (b) PNES; (c) Other nonepileptic seizures (syncope, movement disorder, migraine, etc.); (d) "Cannot Say"; and (3) explain in their own words the main reasons leading to the diagnosis of choice. The results were compared to those of four blind epileptologists who independently reviewed the same cases. The inter-rater reliability was tested with the Kappa statistic.Results: All psychiatrists were concordant and correct in 3/23 video-events, compared to 8/23 among epileptologists. Despite widespread disagreement among themselves and frequent failures as a group, individual psychiatrists scored a comparable number of correct diagnoses as did individual epileptologists. The comments provided to justify the diagnosis of choice differed from neurologists, varied among raters, and reflected considerable attention to body movements and body language.Conclusion: Psychiatrists, as a group, are less reliable than neurologists in differentiating seizure types on video but, as individuals, can be quite accurate in making the correct diagnosis because they are more attuned to capture the subtleties of human behaviour, of subjective experiences, as the effects of hidden internal conflicts and can contribute a new lexicon in defining PNES. [ABSTRACT FROM AUTHOR]

Purpose: Altered responsiveness during psychogenic nonepileptic seizures (PNES) is a distinct semiological feature that may signal a psychological vulnerability. We hypothesized that altered responsiveness is related to difficulties with emotion tolerance, experiential avoidance, difficulty coping, dissociation and trauma and prior experiences of loss of awareness.Methods: 71 patients with video-EEG confirmed PNES were divided into two groups based on their responsiveness at the time of the captured event during long-term monitoring. Demographic information, clinical history and self-rated questionnaires highlighting psychopathology were compared between the groups.Results: 47 patients (66%) had altered responsiveness during their captured event. Married or partnered subjects were more represented in the altered responsiveness group. Experiential avoidance, as measured by the Acceptance and Action Questionnaire-II, and affect intolerance, as measured by the Affective Style Questionnaire, were significantly higher in the altered responsiveness group. The Connor Davidson Resilience Scale was significantly higher among intact responsiveness subjects. Subjects with altered responsiveness were more likely to have a family history of seizures, comorbid headaches, and loss of consciousness (LOC) during traumatic brain injury. There were no differences in measures of dissociation, somatization, mood or anxiety, or presence of psychiatric comorbidities, including PTSD or history of trauma.Conclusion: Altered responsiveness during PNES is a marker of lower emotional resilience or ability to tolerate emotions among patients with PNES. Emotion management may be an important therapeutic target for these patients. Prior experiences with LOC also contribute to the presence of altered responsiveness. Trauma and dissociation did not differentiate responsiveness during PNES. [ABSTRACT FROM AUTHOR]

Here we propose the term hypercognitive seizures as a descriptor for seizures that manifest as a transient mental experience of intrusive thoughts or words that do not consist mainly of reminiscence. Currently, the term forced thinking is used to describe this uncommon seizure semiology, which has also been elicited by electrical brain stimulation. The available literature on forced thinking shows discordant interpretations of its meaning, justifying the suggestion of a new descriptor. In this paper, we would like to suggest and explain the term hypercognitive seizure and argue that this type of seizure lateralizes to the dominant hemisphere. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Le présent article vise à établir comment, au cours de différentes époques de l’histoire de la psychiatrie, depuis le début du XIX e siècle, ont été transmises les connaissances concernant la clinique et la sémiologie des troubles mentaux acquises, en France et dans d’autres pays, notamment ceux de langue allemande ou anglaise. Méthode Nous avons relu les articles publiés sur ces sujets ainsi que ce qu’en disent les ouvrages tels que les manuels et les traités de psychiatrie, notamment ceux visant à transmettre aux étudiants et aux jeunes praticiens les connaissances nécessaires pour leur permettre de formuler un diagnostic positif et différentiel de troubles ou de maladie mentale et d’indiquer aux personnes atteintes une démarche thérapeutique. Résultats Nous avons constaté que d’une manière générale la plupart de ces ouvrages pédagogiques commencent par faire un exposé sur l’historique des entités nosologiques étudiées. Discussion Cependant, certains manuels à visée essentiellement statistique suppriment les références historiques pour définir les catégories diagnostiques retenues, l’exemple le plus frappant étant l’abandon par le DSM-III pour désigner certaines d’entre elles de dénominations historiques comme celles de « névrose » et de « psychoses » ou la désignation par des éponymes utilisés depuis près de deux siècles par les psychiatres pour parler de ces formes cliniques diverses. Conclusion Il apparaît nécessaire que les auteurs de manuels de psychiatrie actuels, surtout ceux destinés à l’enseignement de la clinique psychiatrique aux étudiants, s’ils jugent opportun de changer la terminologie pour certaines catégories diagnostiques puissent en expliquer les raisons surtout d’ailleurs si celles-ci sont dues à une évolution des idées sur ces questions. Aims The present article sets out to determine how knowledge concerning clinical practice and semiology relating to acquired mental disorders have been circulated and taught in France and in other countries, in particular German and English-speaking countries, through the different periods in the history of psychiatry since the start of the 19th century. Method The method entailed the perusal of articles published on these themes, and of commentaries on these articles, for instance in teaching manuals and psychiatric treatises. There was a particular focus on texts intended to provide students and young clinicians with the knowledge and skills needed to establish a positive, differential diagnosis of mental disorders or illnesses and to recommend a therapeutic approach for the individuals concerned. Results It was noted that in general most of the pedagogical writings start by providing a historical overview of the nosological entities considered. Discussion However, certain manuals mainly targeting statistical aspects do away with the historical references in their definitions of the diagnostic categories to be considered. The most striking example is the DSM-III, which in its definition of certain categories abandoned historical terms such as “neurosis” and “psychosis”, or the use of eponymous terms used for more than two centuries by psychiatrists to refer to these various conditions. Conclusion When authors of contemporary psychiatric manuals, in particular those intended for students in clinical psychiatry, consider it necessary to alter the terminology for certain diagnostic categories, it seems important that they should explain their reasons for these changes, in particular when they result from evolutions in ideas on the particular issues. [ABSTRACT FROM AUTHOR]

Purpose Refractory status epilepticus (RSE) is a neurological emergency with significant morbidity and mortality. We aimed to analyze the long-term outcome of intensive care unit (ICU)-treated RSE and super-refractory status epilepticus (SRSE) patients in a population based cohort. Methods A retrospective study of ICU- and anesthesia-treated RSE patients in Kuopio University Hospital’s (KUH) special responsibility area hospitals in the central and eastern part of Finland from Jan. 1, 2010 to Dec. 31, 2012 was conducted. KUH’s catchment area consists of five hospitals—one university hospital and four central hospitals—and covers a population of 840 000. We included all consecutive adult (16 years or older) RSE patients admitted in the participating ICUs during the 3-year period and excluded patients with postanoxic etiologies. We used a modified Rankin Scale (mRS) as a long-term (1-year) outcome measure: good (mRS 0–3, recovered to baseline function) or poor (mRS 4–6, major functional deficit or death). Key findings We identified 75 patients with ICU- and anesthesia-treated RSE, corresponding to an annual incidence of 3.0 (95% confidence interval (CI) 2.4–3.8). 21% of the patients were classified as SRSE, with the annual incidence being 0.6/100 000 (95% CI 0.4–1.0). For RSE, the ICU mortality was 0%, hospital mortality was 7% (95% CI 1.2%–12.8%) (n = 5), and one-year mortality was 23% (CI 95% 13.4%–32.5%) (n = 17). 48% (n = 36) of RSE patients recovered to baseline, and 29% (n = 22) showed neurological deficit at 1 year. Poor outcome (mRS 4–6) was recorded for 52% (n = 39) of the patients. Older age was associated with poorer outcome at 1 year (p = 0.03). For SRSE, hospital mortality was 6% (n = 1) and 1-year mortality was 19% (n = 3) (95%CI 0%–38.2%). Significance During 1-year follow-up, nearly 50% of the ICU-treated RSE patients recovered to baseline function, whereas 30% showed new functional defects and 20% died. SRSE does not have a necessarily poorer outcome. The outcome is worse in older patients and in patients with progressive or fatal etiologies. SE should be treated with generalized anesthesia only in refractory cases after failure of adequately used first- and second-line antiepileptic drugs. [ABSTRACT FROM AUTHOR]

Résumé L’anxiété peut varier d’un état émotionnel simple et physiologique à des pathologies structurées avec des syndromes bien établis comme le sont les troubles phobiques, le trouble panique ou encore le trouble anxiété généralisée. Dans cet article, nous présentons d’abord les composantes motrices de l’anxiété infraclinique (la gêne simple) et de la peur aiguë. On retrouve essentiellement : tension musculaire, tremblements, instabilité, modifications de la posture (repli, défense, autocontact), de la mimique ou du comportement (agitation ou inhibition). Nous montrons ensuite comment la sémiologie motrice s’intègre dans la description des principaux troubles anxieux et obsessionnels (classifications et échelles d’évaluation). Pour certains de ces troubles, la phobie sociale par exemple, des approches spécifiques comme l’étude de l’oculomotricité peuvent permettre d’objectiver des signes moteurs plus subtils. En ce qui concerne les troubles obsessionnels-compulsifs, ils peuvent s’avérer également marqués par une dimension motrice particulière, avec des gestes répétitifs, inopérants, et des modifications du comportement spatial. Enfin, nous discutons de l’intérêt de l’utilisation de la réalité virtuelle dans l’exploration de cette symptomatologie motrice identifiée dans les troubles anxieux et obsessionnels. Anxiety can vary from simple and physiological emotional states to structured pathologies with well-established syndromes such as phobia, panic disorder or generalized anxiety. In this article, we firstly present the motor components of subclinical anxiety (simple embarrassment) and acute fear. These components are represented by: muscular tension, tremor, instability, posture changes (withdrawal, defense, self-contact), facial expression or behaviour (agitation or inhibition). Then, we show how motor semiology fit in the description of the main anxiety and obsessive-compulsive disorders (classifications and rating scales). For some of these disorders, social anxiety for example, specific approaches as eye movement studies can highlight subtle motor signs. Regarding obsessive-compulsive disorders, they are characterized by a particular motor dimension, with repetitive, specific and non-operant gestures, and modifications of spatial behaviour. Finally, we discuss the interest of using virtual reality to explore the motor symptomatology in anxiety disorders. [ABSTRACT FROM AUTHOR]

Résumé En pratique clinique psychiatrique quotidienne, il faut savoir rechercher et identifier des pathologies neurologiques pouvant s’exprimer, au cours de leur évolution, par des symptômes psychiatriques. L’objectif de cet article est de faire un inventaire, non exhaustif, des pathologies neurologiques pouvant présenter des manifestations d’allure psychiatrique, afin de mettre en évidence l’importance de l’examen neurologique en psychiatrie. Un autre objectif est de proposer un examen neurologique standardisé, facile à suivre et à compléter, aide pratique pour le clinicien au quotidien. In daily clinical psychiatric practice, it is necessary to be able to identify neurological disorders that can be expressed by psychiatric symptoms. The aim of this article is to briefly review neurological disorders that may have psychiatric manifestations, emphasizing the importance of neurologic examination in psychiatry. Another objective is to present an easy to follow neurologic examination to help the clinician for daily practice. [ABSTRACT FROM AUTHOR]

Résumé Le syndrome catatonique est un syndrome psychiatrique ancien dont la définition et le repérage en pratique clinique restent encore mal connus. Les symptômes et signes peuvent être discrets, subtils, et difficiles à identifier. Le syndrome catatonique souffre donc d’un retard d’identification. La sémiologie du syndrome catatonique résulte d’une interaction entre trois groupes de signes et symptômes : des signes moteurs (immobilité, stupeur, mutisme, fixité du regard, repli sur soi, refus alimentaire, prise de posture, agitation psychomotrice, impulsivité, maintien d’expressions faciales inadaptées, stéréotypie, maniérisme, catalepsie, flexibilité cireuse, négativisme, oppositionnisme), des signes comportementaux donnant une impression de dépendance à l’environnement (comportements d’imitation, comportements d’utilisation, attitudes d’aimantation) et des signes neurovégétatifs. Ce syndrome est devenu, de manière largement admise aujourd’hui, un syndrome clinique transnosographique. Il est impératif de le reconnaître afin de le traiter rapidement, car certaines étiologies à l’origine de ce syndrome et les conséquences du syndrome lui-même peuvent engager le pronostic vital. The catatonic syndrome remains a syndrome whose definition and identification in clinical practice are little known, unfamiliar for many clinicians. The symptoms may be subtle and difficult to identify. The semiology of the catatonic syndrome results from an interaction between three groups of signs and symptoms: motor signs (immobility, stupor, mutism, fixity of gaze, withdrawal, refusal of food, posture, psychomotor agitation, impulsivity, facial expressions, stereotypy, mannerism, catalepsy, waxy flexibility, negativism, oppositionism), behavioral signs giving an impression of dependence on the environment (imitation behaviors, utilization behaviors, magnetization behaviors) and neurovegetative signs. This syndrome has become, in a widely accepted way today, a transnosographic clinical syndrome. It is imperative to recognize this semiology in order to treat it quickly. Indeed, the etiologies of this syndrome and the consequences of the syndrome, can engage the vital prognosis. [ABSTRACT FROM AUTHOR]

Résumé Les troubles moteurs tardifs induits par antipsychotiques (TMTA) sont des manifestations motrices tardives et involontaires, secondaires à un blocage dopaminergique. Les TMTA sont souvent peu repérés par les professionnels de santé, alors qu’ils restent susceptibles de survenir avec les nouvelles générations d’antipsychotiques. Les TMTA peuvent induire une gêne motrice ou psychique entraînant un handicap et une stigmatisation considérables. Les TMTA regroupent des entités cliniques spécifiques : dyskinésies, stéréotypies, dystonies, myoclonies, akathisies, tics, tremblements, chorée, dyskinésies émergentes au cours du sevrage d’un neuroleptique et parkinsonisme. La prévalence des TMTA est élevée et l’évolution habituellement fluctuante. Le facteur de risque le plus connu est l’âge. Évaluer l’intérêt du traitement antipsychotique en fonction du terrain et réaliser un examen neurologique régulier pour repérer précocement l’apparition d’un TMTA sont essentiels en prévention primaire ou secondaire. La prise en charge repose sur l’adaptation du traitement antipsychotique (diminution, arrêt, ou changement), l’utilisation de molécules spécifiques (i.e., réserpine) dont les preuves d’efficacité restent encore limitées, ou encore la chirurgie en cas de symptômes sévères et résistants. Antipsychotic-induced tardive movement disorders (ATMDs) constitute a set of late-onset involuntary movements, resulting from the blocking of dopamine receptors. ATMDs are generally underscreened by health professionals, though they may also occur with new generation antipsychotics. ATMDs encompass several specific clinical types: tardive dyskinesia, tardive dystonia, tardive akathisia, tardive tremor, tardive myoclonus, tardive stereotypy, tardive tourettism, tardive parkinsonism, and withdrawal emergent syndrome. The prevalence rates of ATMDs are high, and the outcome may be variable. The most evidenced risk factor for ATMDs is age. Primary and secondary prevention rely on systematically assessing the clinical risk factors before prescribing an antipsychotic medication, and regularly undertaking a neurological examination. Managing ATMDs requires decreasing, stopping, or changing the antipsychotic treatment. Specific reversing drugs, such as reserpine, can be used, though the levels of evidence of these drugs are low. Surgery can be considered in the case of severe and resistant ATMDs. [ABSTRACT FROM AUTHOR]

Résumé Les crises non épileptiques psychogènes (CNEP) sont définies comme un changement brutal du comportement, des perceptions, des pensées ou des émotions d’un sujet pendant une durée limitée, qui ressemble à une crise d’épilepsie, mais sans l’activité concomitante électrophysiologique associée à une crise épileptique. Il existe une nette prédominance féminine (75 %) dans la plupart des études. Le début de la maladie se situe typiquement dans la deuxième ou troisième décennie. Environ 80 % des patients ont des antécédents de traumatismes ou de maltraitance. La compréhension des CNEP nécessite l’analyse de trois types de facteurs, les 3 P : prédisposants (de vulnérabilité), précipitants (déclenchants) et perpétuants (de maintien). Ces facteurs ne sont pas toujours tous retrouvés chez un patient donné. Il existerait une corrélation entre le dysfonctionnement de certains réseaux cérébraux et les taux de dissociation chez des patients souffrant de CNEP. Il existerait une dysrégulation émotionnelle complexe observée chez certains malades souffrant de CNEP. L’analyse sémiologique en vidéo-EEG permet d’identifier des associations caractéristiques de signes lors des crises permettant de distinguer cinq sous-types cliniques qui, associés à l’analyse sémiologique des 3 P, permettent de poser le diagnostic de CNEP. L’annonce diagnostique des CNEP est une étape délicate, mais importante pour entamer une première phase thérapeutique : elle conditionne le pronostic des patients souffrant de CNEP. L’annonce diagnostique et la prise en charge nécessite une collaboration étroite entre neurologues et psychiatres. Psychogenic Non Epileptic Seizure (PNES) are defined as paroxysmal and transient behavioral manifestations, suggestive of epileptic seizures, but without the concomitant electro physiological activity linked to an epileptic seizure. There is a net female predominance (75 %). The beginning of illness is typically in the second or third decade. About 80 % patients have antecedents of traumatisms. The understanding of PNES requires the analysis of three types of factors (3P): predisposing, precipitating, and perpetuating factors. These factors all are not always found. There would be a correlation between the dysfunction of some cerebral networks and the dissociation for patients suffering from PNES. There would be a complex emotional dysfunction for some patients suffering from PNES. The semiological analysis in video-EEG allows to identify characteristic associations of signs during seizure allowing to differentiate five clinical subcategories which linked to the semiological analysis of 3 P allow to diagnose PNES. The diagnostic announcement of PNES is a delicate stage, but important to start a first therapeutic stage: it conditions the forecast of the patients suffering from PNES. The diagnostic announcement and the taking care require a close collaboration between neurologists and psychiatrists. [ABSTRACT FROM AUTHOR]

In this paper an integrationist linguist (Peter E Jones) and an Ecological Psychologist (Catherine Read) open a dialogue on the possibility of a productive relationship between the integrationist approach to language and communication of Roy Harris and James Gibson's Ecological Psychology of perceiving/acting/knowing. Within their own disciplinary contexts, each position is one of profound critique and innovation in relation to established and pervasive 'myths'. Specifically, Harris is concerned with the 'language myth'—the explicit positions and implicit assumptions in the Western language tradition (including modern linguistics) about the nature of language and the relationship between language and communication. In sharp contrast to mainstream approaches, Harris rejects both coding and representational views of meaning and takes signs (including linguistic signs) to be the product, rather than the precondition, of communicational activity. Similarly, Gibson critiques assumptions about how perception takes place, especially in the case of vision, that have informed Western science at least since Descartes' Optics. In particular, Gibson rejects the passive 'retinal image fallacy' of seeing in favour of an activity based non-representational perspective of 'direct perception'. The paper offers a critical dialogue over the key theoretical perspectives of both traditions, focusing particularly on the import and implications of each theorist's claims and assumptions about the other's field. Highlighting key areas of apparent common ground across the two approaches, we also argue that Gibson appears not to be entirely free of assumptions about language that belong to Harris's 'language myth', while Harris appears at times to assume the 'image' based model of perception that Gibson rejected. In the context of current interest in a possible reconciliation or combination of integrational linguistics and Ecological Psychology, the paper, therefore, raises fundamental questions around the extent to which these independently developed programmes of demythologization are compatible or possibly synergistic. • The possibility of a productive relationship between Harris's Integrational Linguistics and Gibson's Ecological Psychology is considered. • Harris and Gibson both reject a traditional view of perception as involving the transmission of signs. • Harris's integrational view of sign-making offers a perspective on communication that Gibson had not considered. • Harris's views on perception appear to assume the 'retinal image myth' which Gibson rejected in favour of 'direct perception'. [ABSTRACT FROM AUTHOR]

We examined the clinical, semiological, scalp electroencephalographic (EEG), and neuropsychological features of patients with amygdalar hamartoma-like lesion (AHL) without hippocampal sclerosis (HS). This retrospective study included 9 patients with mesial temporal lobe epilepsy (MTLE) who had an amygdalar lesion on preoperative MRI; underwent mesial temporal resection; were diagnosed with amygdalar hamartoma-like lesion (AHL) without hippocampal sclerosis (HS); were followed up for at least 2 years after surgery; and had a favourable postoperative seizure outcome (Engel Class I). There were 5 women and 4 men, and age at surgery ranged from 19 to 54 (mean, 36.6) years. Clinical characteristics, auras, video-recorded seizure semiology, interictal and ictal EEG, and preoperative neuropsychological data were reviewed. Twenty patients with MTLE with HS who had favourable postoperative seizure outcomes (Engel Class I) were selected as controls. Age at seizure onset was significantly higher in patients with AHL without HS than in those with HS. Fear was more frequently seen in patients with AHL (44 %) than in those with HS (5 %) (P = 0.022). There were no significant differences in interictal epileptiform discharges or ictal EEG pattern. Preoperative full-scale IQ score was significantly higher in the AHL group than in the HS group (mean, 92.9 v. 74.8, P = 0.004), as was preoperative memory quotient score (mean 100.7 v. 85.1, P = 0.028). We clarified the clinical, semiological, and neuropsychological features of patients with MTLE-AHL. These findings may be useful for preoperative evaluation, especially of patients with suspected MTLE but without apparent HS on preoperative MRI. • Amygdalar hamartoma (AH) without hippocampal sclerosis (HS) was examined. • All the patients underwent epilepsy surgery with favourable seizure outcome. • Age at seizure onset was higher in AHL group than in HS group. • Fear was more frequently seen in AHL group than in HS group. • Preoperative IQ and memory scores were higher in AHL group than in HS group. [ABSTRACT FROM AUTHOR]