Objectives: To determine whether the assessment of orofacial praxis is useful for the differential diagnosis of parkinsonian syndromes and to understand the neural mechanisms underlying OFA, searching for the respecti...Objectives: To determine whether the assessment of orofacial praxis is useful for the differential diagnosis of parkinsonian syndromes and to understand the neural mechanisms underlying OFA, searching for the respective roles of cortical and subcortical structures. Methods: Forty- four patients were assessed: 12 with idiopathic Parkinson’ s disease (IPD), 8 with multiple system atrophy (MSA), 12 with progressive supranuclear palsy (PSP) and 12 with corticobasal degeneration (CBD). An easy bedside scale was used, exploring single gestures, gestures with noise production and multiple sequential gestures. We searched for group and task effects. Results: Patients with CBD were significantly more impaired than those with IPD, MSA or PSP (p < 0.001). Our assessment was unable to distinguish between the IPD, MSA and PSP groups. There was a clear task effect in CBD with a major impairment in multiple sequential gestures (p < 0.0001). Conclusion: Assessment of orofacial praxis helps in the clinical diagnosis of CBD. Patients with IPD, MSA and PSP did not present with OFA. We suggest that the deficit in multiple sequential gestures in CBD is related to simultaneous lesions of the parietal lobule and the supplementary motor area.展开更多
Neuropsychological testing is an integral part of investigation and management of pharmacologically intractable epilepsy. Patients often complain of cognitive difficulties, in particular memory disturbances. A review ...Neuropsychological testing is an integral part of investigation and management of pharmacologically intractable epilepsy. Patients often complain of cognitive difficulties, in particular memory disturbances. A review of the literature dem onstrates that correlations between subjective memory difficulties and objective memory deficits are often poor with mood correlating more consistently with sub jective complaints. Nevertheless, objective memory difficulties are often found, especially in patients with temporal lobe epilepsy. Many factors can contribute to cognitive difficulties in patients with pharmacoresistant partial epilepsy. These include brain pathology that may be the cause or the consequence of chroni c seizures (or both), physiological brain dysfunction due to epileptic activity and effects of antiepileptic medications. We review some of the abundant relevan t literature. Neuropsychological evaluation is routinely used in pre surgical e valuations of patients and cognitive dysfunction has some degree of correlation with lateralization and localization of epileptic activity, thus helping to dete rmine a surgical strategy. The goal of seizure control is tempered with an asses sment of the potential cognitive loss resulting from resective surgery. A number of studies have addressed postoperative neuropsychological findings and it is u niversally recognized that patients who have high levels of cognitive functionin g in the areas targeted for resection (for instance verbal memory in dominant te mporal lobe) show the greatest functional loss following surgery. More selective surgery probably results in some level of preservation of cognitive function.展开更多
Introduction. For Parkinson’s disease, the choice of the initial treatment is essentially between L-Dopa and dopaminergic agonists. Selegilin, anticholin ergic and amantadine can be used for subjects with moderate sy...Introduction. For Parkinson’s disease, the choice of the initial treatment is essentially between L-Dopa and dopaminergic agonists. Selegilin, anticholin ergic and amantadine can be used for subjects with moderate symptoms. The first French consensus conference, held in 2000, elaborated decision-making rules wh ich take into account both the age and disease severity. The aim of our study wa s to evaluate the impact of these recommendations on treatments prescribed for de novo parkinsonian patients in the Nord-Pas de Calais area, comparing initial prescriptions before and after the conference. Methods. Three groups of 50 patients whose diagnosis of Parkinson’s diseaseha d been establish in three periods (1985- 1992, 1993- 1999, and after July 2000 , date of the national publication of the consensus) were constituted. Results. For these 3 groups, the initial treatment complied with the 2000 recommendations for 58, 84 and 82 percent of the patients respectively. The prescriptions of ag onists increased progressively while the prescriptions of L-Dopa decreased for younger patients, in concordance with the consensus, but also for older patient s, in opposition with the recommendations, though without any increase in the incidence of side effects. The non dopaminergic treatments were almost discar ded as initial treatment. Conclusion. Prescription habits have gradually changed over the past 10 years. Changes were linked to the elaboration of the national consensus conference guidelines and to the apparent desire to decrease L-Dopa prescriptions.展开更多
A consensus is that, in patients with partial epilepsy, magnetic resonance ima ging is necessary to identify the underlying epileptogenic lesion, to determine the likely site of seizure onset, and contribute to the se...A consensus is that, in patients with partial epilepsy, magnetic resonance ima ging is necessary to identify the underlying epileptogenic lesion, to determine the likely site of seizure onset, and contribute to the selection of appropriate candidates for epilepsy surgery. Despite variable protocols and a continuously evolving technology, a cautious analysis of available literature provides some g eneral guidelines for clinical practice.展开更多
文摘Objectives: To determine whether the assessment of orofacial praxis is useful for the differential diagnosis of parkinsonian syndromes and to understand the neural mechanisms underlying OFA, searching for the respective roles of cortical and subcortical structures. Methods: Forty- four patients were assessed: 12 with idiopathic Parkinson’ s disease (IPD), 8 with multiple system atrophy (MSA), 12 with progressive supranuclear palsy (PSP) and 12 with corticobasal degeneration (CBD). An easy bedside scale was used, exploring single gestures, gestures with noise production and multiple sequential gestures. We searched for group and task effects. Results: Patients with CBD were significantly more impaired than those with IPD, MSA or PSP (p < 0.001). Our assessment was unable to distinguish between the IPD, MSA and PSP groups. There was a clear task effect in CBD with a major impairment in multiple sequential gestures (p < 0.0001). Conclusion: Assessment of orofacial praxis helps in the clinical diagnosis of CBD. Patients with IPD, MSA and PSP did not present with OFA. We suggest that the deficit in multiple sequential gestures in CBD is related to simultaneous lesions of the parietal lobule and the supplementary motor area.
文摘Neuropsychological testing is an integral part of investigation and management of pharmacologically intractable epilepsy. Patients often complain of cognitive difficulties, in particular memory disturbances. A review of the literature dem onstrates that correlations between subjective memory difficulties and objective memory deficits are often poor with mood correlating more consistently with sub jective complaints. Nevertheless, objective memory difficulties are often found, especially in patients with temporal lobe epilepsy. Many factors can contribute to cognitive difficulties in patients with pharmacoresistant partial epilepsy. These include brain pathology that may be the cause or the consequence of chroni c seizures (or both), physiological brain dysfunction due to epileptic activity and effects of antiepileptic medications. We review some of the abundant relevan t literature. Neuropsychological evaluation is routinely used in pre surgical e valuations of patients and cognitive dysfunction has some degree of correlation with lateralization and localization of epileptic activity, thus helping to dete rmine a surgical strategy. The goal of seizure control is tempered with an asses sment of the potential cognitive loss resulting from resective surgery. A number of studies have addressed postoperative neuropsychological findings and it is u niversally recognized that patients who have high levels of cognitive functionin g in the areas targeted for resection (for instance verbal memory in dominant te mporal lobe) show the greatest functional loss following surgery. More selective surgery probably results in some level of preservation of cognitive function.
文摘Introduction. For Parkinson’s disease, the choice of the initial treatment is essentially between L-Dopa and dopaminergic agonists. Selegilin, anticholin ergic and amantadine can be used for subjects with moderate symptoms. The first French consensus conference, held in 2000, elaborated decision-making rules wh ich take into account both the age and disease severity. The aim of our study wa s to evaluate the impact of these recommendations on treatments prescribed for de novo parkinsonian patients in the Nord-Pas de Calais area, comparing initial prescriptions before and after the conference. Methods. Three groups of 50 patients whose diagnosis of Parkinson’s diseaseha d been establish in three periods (1985- 1992, 1993- 1999, and after July 2000 , date of the national publication of the consensus) were constituted. Results. For these 3 groups, the initial treatment complied with the 2000 recommendations for 58, 84 and 82 percent of the patients respectively. The prescriptions of ag onists increased progressively while the prescriptions of L-Dopa decreased for younger patients, in concordance with the consensus, but also for older patient s, in opposition with the recommendations, though without any increase in the incidence of side effects. The non dopaminergic treatments were almost discar ded as initial treatment. Conclusion. Prescription habits have gradually changed over the past 10 years. Changes were linked to the elaboration of the national consensus conference guidelines and to the apparent desire to decrease L-Dopa prescriptions.
文摘A consensus is that, in patients with partial epilepsy, magnetic resonance ima ging is necessary to identify the underlying epileptogenic lesion, to determine the likely site of seizure onset, and contribute to the selection of appropriate candidates for epilepsy surgery. Despite variable protocols and a continuously evolving technology, a cautious analysis of available literature provides some g eneral guidelines for clinical practice.
