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Objective The aim of this study was to determine the success rate of sEEG in locating the epileptogenic zone (EZ) in patients with pharmaco-resistant epilepsy. Secondary objectives were to analyze sEEG-related morbidity and outcomes for post-sEEG thermocoagulation and cortical resection. Methods Data were collected on 49 sEEGs from 46 consecutive patients between 2010 and 2018. Following sEEG, either resective or palliative surgery with vagus nerve stimulation was performed. In 8 patients, EZ thermocoagulation was performed before EEG leads were withdrawn. Outcomes were collected based on the Engel and ILAE outcome scales. Results sEEG was contributive in 45 of 49 recordings, with a success rate of 92% in locating the EZ. Minor complications, such as transient neurologic deficit and electrode implantation failures, occurred in 6%. One major complication occurred, with death due to atypical late hematoma. Thermocoagulation was performed in 8 patients and stopped or significantly reduced seizure frequency in 7 (88%). Outcome of surgical resection (n = 33) was good, with 20 (61%) seizure-free patients and 32 (97%) with definite improvement. Conclusions Our findings suggest that sEEG is an effective technique for EZ location in patients with drug-resistant epilepsy. sEEG was contributive in up to 92% of patients, allowing thermocoagulation and/or surgical resection that resulted in seizure-freedom in two-thirds and seizure-reduction in one-third of cases. This study highlights the need for strict selection of implantation candidates, with strong initial hypothesis as to EZ location.

Anterior sagittal imbalance (ASI) is a severity factor in spinal pathology. Stabilometric study of the dynamic position of the center of pressure (CoP) assesses orthostatic control. These analyses provide the energy expenditure used for this control.Stabilometric signs are associated with ASI indicate increased energy expenditure.Healthy male volunteers were subjected to reversible ASI induced by wearing a kyphotic thermoformed thoracolumbar corset. The deformation was assessed by C7 tilt on EOS whole-spine views. Static and dynamic posturographic force platform study was performed under conditions of anteroposterior and mediolateral instability. Mean CoP position (XThe corset significantly increased C7 tilt (p0.0001). This did not significantly change mean CoP positions (XPosturographic parameters were impacted by inducing ASI in healthy subjects. Significant differences were seen in stabilography, CE and LAS, were greater on dynamic testing, and correlated with radiologic sagittal balance. Force platforms can reveal increased energy expenditure in maintaining posture.II; Single-center prospective study involving healthy volunteers.

Resume Objectifs Evaluer l’efficacite de la rTMS « a large champ » dans la fibromyalgie. Une evaluation multidimensionnelle a ete realisee avec pour critere de jugement principal l’echelle numerique de la douleur et criteres secondaires les scores FIQ, MFI-20, HAD et WPI - SSS. Methodologie Essai clinique monocentrique ouvert, realise en neurophysiologie chez des patients atteints de fibromyalgie consultant au Centre d’evaluation et traitement de la douleur du CHU de Rouen entre novembre 2014 et juin 2016. Les patients etaient inclus sur la base du FIRST, des criteres ACR 1990 et ACR 2010. Les donnees etaient recueillies sur autoquestionnaires a j1, j7, j15 et j30 (EN douleur, scores FIQ, HAD, MFI-20 et WPI–SSS). Un examen clinique avec recherche des points de Yunus etait realise a j1 et j30. Trois seances de stimulations magnetiques transcrâniennes, espacees sur 5 a 8 jours, ont ete realisees pour chaque patient. Les seances comprenaient 30 stimulations, renouvelees 3 fois, soit 90 stimulations par seances. Resultats Vingt-et-un patients ont ete inclus. L’EN douleur, le FIQ et le HAD anxiete etaient significativement ameliores a j7 (respectivement p = 0,004, p = 0,007 et p = 0,049) et cette efficacite persistait jusqu’a j30. L’amelioration de la douleur portait a la fois sur les caracteristiques affectives et sensorielles au QDSA evalue a j30 ( p = 0,02). Le WPI etait significativement ameliore a j7 ( p = 0,049) mais cette efficacite disparaissait au cours du suivi. L’amelioration du MFI etait retardee par rapport aux stimulations (j30, p = 0,04) ainsi que l’amelioration du score HAD depression (j15, p = 0,007 et j30, p = 0,049). Conclusion La rTMS « a large champ » permet une amelioration des patients fibromyalgiques dans les multiples dimensions etudiees. Un essai clinique randomise controle devrait etre realise pour confirmer les resultats preliminaires.

Introduction Les premieres etudes de vie reelle concernant la tolerance du perampanel (PER) alertent sur des effets indesirables psychiatriques. Objectifs L’objectif principal de l’etude est d’identifier des facteurs de risque de developper des effets indesirables psychiatriques sous PER. Les objectifs secondaires sont d’evaluer l’efficacite et la tolerance globale du traitement. Patients et Methodes Cette etude retrospective, monocentrique au CHU de Rouen, inclut les patients adultes traites par perampanel entre mars 2014 et mars 2018. Nous avons separe la population en 2 groupes : ceux ayant presente des effets indesirables psychiatriques et les autres. Nous avons compare ces groupes a 9 variables : sexe, âge, âge de debut d’epilepsie, antecedents psychiatriques, effets indesirables psychiatriques sous un autre antiepileptique, trouble cognitif, epilepsie focale, nombre de traitements associes, posologie du PER. Resultats Soixante-dix-huit patients ont ete inclus, dont 85,9 % de pharmacoresistants. Le taux de retention du PER etait de 48,7 %. Au total, 11,5 % etaient libres de crise et 33,3 % repondeurs. Cinquante-neuf pour cent ont eu des effets indesirables dont 42 % psychiatriques. Les antecedents psychiatriques existent chez 17 patients (51,5 %) dans le groupe « effets indesirables psychiatriques » vs 8 (17,7 %) dans l’autre p = 0,003 ; les effets indesirables psychiatriques sous un autre antiepileptique sont presents respectivement chez 13 patients (39,4 %) vs 8 (17,7 %) p = 0,041. Discussion Dans notre etude, les taux de retention du PER et d’efficacite sont comparables aux donnees des autres etudes. Dans ces dernieres, la frequence de survenue d’effets indesirables psychiatriques varie entre 1,4 % et 54,5 %, vs 42 % dans notre etude. Un antecedent psychiatrique ou d’effet indesirable psychiatrique sous un autre antiepileptique augmente le risque de developper un effet indesirable psychiatrique sous PER. Conclusion Les antecedents psychiatriques et les antecedents d’effets indesirables psychiatriques sous un autre antiepileptique sont des potentiels facteurs de risque de mauvaise tolerance psychiatrique du perampanel.

Backgrounds Worsening of verbal fluency is reported after subthalamic nucleus deep brain stimulation in Parkinson's disease. It is postulated that these changes could reflect microlesion consecutive to the surgical procedure itself. Methods We evaluated verbal fluency, in 26 patients (mean age, 57.9 ± 8.5 years; mean disease duration, 11.4 ± 3.5 years) both before surgery (baseline) and, after surgery respectively the third day (T3), the tenth day (T10) just after STN implantation before turning on the stimulation and at six months (T180). Results Number of total words and switches was significantly reduced at T3 and T10, while average cluster size was unchanged. Repeated post-operative neuropsychological testing demonstrated reliable improvement from T3 to T180 on verbal fluency. Conclusion This study provides evidence of transient verbal fluency decline consecutive to a microlesion effect. Further studies needed to determine a putative relationship between early and long-term verbal fluency impairment.

Resume Une formation medicale continue necessite un travail de preparation dont le but est de stimuler les processus cognitifs favorisant l’apprentissage : la motivation, la perception, l’attention, la memoire, les representations et les connaissances anterieures, le statut de l’erreur et l’effet enseignant. Il faut une planification systematique des apprentissages surtout si l’on se place dans la perspective de faciliter l’apprentissage des participants. Les etapes de cette planification sont : la determination des besoins educatifs, la formulation des objectifs d’apprentissage, la determination de la methode pedagogique, la mesure de l’atteinte des objectifs par les apprenants et enfin l’evaluation de l’activite.

Objective To analyse postoperative pain due to osteoarthritis in patients with Parkinson's disease submitted to bilateral subthalamic nucleus stimulation. Methods Fifty-three parkinsonian patients (mean age, 59.9±8.3 years; mean disease duration, 11.5±4.2 years) referred for subthalamic nucleus stimulation were enrolled. Patients were prospectively asked to refer and describe any pain due to osteoarthritis they experienced at any time during the preoperative period and within the 6 postoperative months. Pre-existing pain due to osteoarthritis, therapeutic changes, parkinsonian motor disability and weight gain were assessed as explanatory factors for occurrence pain due to osteoarthritis after surgery. Results After surgery, thirty patients (57%) complained of pain due to osteoarthritis whereas all demonstrated great functional improvement. Twenty (67%) among the 30 experienced similar pain sensation before surgery. Symptoms occurred rapidly, between 4 and 26 postoperative weeks. Multiple stepwise regression analysis showed that pre-existing pain due to osteoarthritis, 6-month postoperative UPDRS III motor score and axial sub-score improvements in the off -drug/ on -stimulation condition were accurate independent predictors of pain due to osteoarthritis after surgery ( F (8,41)=2.20, p Conclusion Our results highlight the high prevalence of pain due to osteoarthritis arising shortly after subthalamic implantation. An accurate pain and osteo-articular assessment should be performed preoperatively in parkinsonian candidates for subthalamic nucleus stimulation in order to limit occurrence of complications in the early postoperative period.

Idiopathic Parkinson's disease (PD) has a long preclinical phase during which non-motor symptoms exist but are not specific. The aim of the study is to determine whether subtle gait disorders are prediagnostic markers of PD. Participants were selected from the Baltimore Longitudinal Study of Aging, including 10 prediagnostic PD (8M/2W) and thirty age-matched healthy controls. Prediagnostic PD were assessed for an average of 2.6 ± 1.3 years (range 1.0–5.3 years) before PD diagnosis with: clinical gait and balance assessment (i.e., 6-meter corridor walk at usual and maximal gait speed, semi-tandem stand, tandem stand, and one-leg stand), instrumental gait analysis (VICON®), upper-limb motor skills (i.e., Hand Rapid Alternating Movement Test, Finger Tapping Test, and Purdue Pegboard Test), neuropsychological assessment (i.e., processing speed, attention, executive functions, memory, language, and visuo-spatial skills), and non-motor symptoms (orthostatic hypotension, depression, sleep disorders, and urinary symptoms). Prediagnostic IPD showed slower gait speed due to shorter step length compared to controls. They also showed greater gait speed variability, which was correlated with falls. No statistically significant differences were found between the two groups for balance, upper-limb motor skills and non-motor symptoms. Prediagnostic PD showed lower visuospatial ability (Card Rotation Test) than controls. The set of variables that best discriminate between the two groups were age, clinical gait speed, Trail-Making Test Part B, and Card Rotation Test with 100% sensibility and 95.8% specificity. This is the first prospective longitudinal study demonstrating gait changes in prediagnostic idiopathic Parkinson's disease. Previous published studies have recruited high-risk population for PD, as asymptomatic carriers of LRRK2 mutation [1] or patients with rapid eye movement sleep behavior disorder [2] , [3] . Our findings could potentially be used as prediagnostic markers of IPD to identify those who could benefit from future neuroprotective therapy in order to delay, or even prevent, clinical manifestations.

Introduction Alzheimer's disease (AD) and Parkinson's disease (PD) are neurodegenerative diseases of increasing prevalence worldwide. In the absence of effective therapy, current research is focused on identifying individuals at high risk, who could be targeted in intervention trials. Today, the field of behavioral neuroscience has emerged as one of the most promising areas of research on this topic. Recently, it has been shown that the exacerbation of gait disorders in dual-task conditions, which involve the concurrent performance of a cognitive task while walking, is a characteristic feature of AD and PD. Objectives This review aims: – to summarize evidence supporting or refuting that the dual-task walking paradigm have added value for early detection of older people at risk for progression to AD or PD; – to propose new dual-task paradigms and markers for more accurate and earlier diagnosis of these diseases. Study selection The following inclusion criteria were used in this review: – used self-paced (comfortable) walking as the primary motor task; – reported gait parameters during both single- and dual-task performance, or dual-tasking effects on gait; – employed secondary cognitive tasks during dual-task walking. Results Dual-task-related gait changes precede the traditional clinical symptoms of AD and PD. Inhibition and flexibility are mostly impaired in preclinical AD and PD, respectively. Strategies in dual-task conditions may differentiate between preclinical AD and PD. A number of issues related to the application of dual-task methodology in gait (e.g., effect of type of cognitive task, choice of gait parameters, complementary use of linear and nonlinear measures) are discussed. Conclusion and perspectives We propose novel dual-task paradigms and markers based on the pathophysiological mechanisms that underlie gait disorders in each disease to advance our knowledge in this innovative area of research.