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The Memory Centres of several Swiss hospitals have set up a national online registry for Alzheimer's research, called www.BHR-suisse.org. This type of registry already exists in the United States (www.brainhealthregistry.org/) and the Netherlands (https://hersenonderzoek.nl/). It contributes, as do these initiating sites, to the creation of a global database of research partnersLes centres de la mémoire de plusieurs hôpitaux suisses ont créé un Registre national suisse en ligne pour la recherche sur Alzheimer, intitulé www.bhr-suisse.org. Ce type de registre existe déjà aux États-Unis (www.brainhealthregistry.org/) et aux Pays-Bas (hersenonderzoek.nl/). Il contribue, au même titre que ces sites initiateurs, à constituer une base de données globale de partenaires de recherche

Status epilepticus is a feared complication in patients with epilepsy with a mortality rate of almost 10%. It is important to recognize this clinical entity quickly. A delay in diagnosis or treatment has significant consequences on mortality and morbidity. This article is a review of the current literature and aims to provide management of status epilepticus in the emergency department by adults.L’état de mal épileptique est une complication redoutée chez le patient épileptique avec un taux de mortalité de presque 10 %. Il est important de reconnaître cette entité clinique rapidement. Un retard de diagnostic ou de prise en charge a des conséquences non négligeables sur la mortalité et la morbidité. Cet article est une revue de la littérature actuelle et a pour but de synthétiser la prise en charge de l’état de mal épileptique aux urgences chez l’adulte.

The actual field of dementia encompasses also the pre-symptomatic phase, which may evolve for decades. Early detection and appropriate diagnosis decrease patient's and family's anxiety, improve patient's global care and allow better legal patient's protection. General Practitioners have at hand several available tools to screen a neurocognitive disorder, with up to 80% of sensitivity and specificity, to complete their clinical evaluation. An accurate diagnosis requires then a complete medical, neurological neuropsychological and neuroradiological evaluation in a Memory Clinic. Other investigations, such as functional cerebral imagery and spinal tap can be critical in unusual situations. Despite mood improvement after diagnostic announcement, increased suicidal risk in the 3 first months should be screened.

In Switzerland, because of the ageing of the population, the number of dementia's cases grows up. This represents a notable social and economic impact. The early detection is the key for a best patient's care. The general practitioner can use, in addition to his clinical approach, a certain number of screening tools in order to detect and diagnose dementia with an acceptable specificity and sensitivity (around 80%). Amongst these tools, we describe a four question questionnaire to the informants, the Mini Mental State Examination, the clock drawing test and the Mementool. A supplementary screening task, the 5 words test can orientate the diagnosis towards an Alzheimer disease or another form of dementia.

Les traitements de substitution qui ont contribué à une politique de réduction des risques efficace doivent actuellement également s'inscrire dans une addictologie «existentielle». Celle-ci donne une place centrale à l'élaboration d'un projet de vie pour la personne souffrant d'addiction. C'est autour de ce projet que les actes de soins vont s'inscrire. Dans cette perspective, la question du thérapeute prenant en soins des patients souffrant d'addiction ne va plus être seulement de prescrire un traitement de substitution, mais surtout pour quels objectifs le prescrire. Ce passage d'une réflexion visant à la survie à une réflexion de soins orientée vers la vie nous impose de passer d'une logique d'urgence avec réponse immédiate pour un patient «passif» à une logique de crise demandant au patient une participation active à son processus de rétablissement.

While dementias represent an important problem of social health, they remained underdiagnosed. Data from the literature suggests that only 30% of cognitive impairment are detected and correctly evaluated, while most of the patient (up to 90%) and caregivers (up to 70-80%) ask for a precise diagnosis. Proper evaluation increase diagnostic accuracy from 30% to 80% but 20% of diagnoses remains inexact. Diagnostic disclosure seems to have a positive impact on patient's affective symptoms but is associated to an increase of suicide during the following 3 months, and thus must be a progressive and controlled process. Accompanying a patient in this process necessitates complexes competencies from the primary care physician. Difficulties related to this disclosure are counterbalanced by benefits for both patient and families.

While dementias represent an important problem of social health, they remained underdiagnosed. Data from the literature suggests that only 30% of cognitive impairment are detected and correctly evaluated, while most of the patient (up to 90%) and caregivers (up to 70-80%) ask for a precise diagnosis. Proper evaluation increase diagnostic accuracy from 30% to 80% but 20% of diagnoses remains inexact. Diagnostic disclosure seems to have a positive impact on patient's affective symptoms but is associated to an increase of suicide during the following 3 months, and thus must be a progressive and controlled process. Accompanying a patient in this process necessitates complexes competencies from the primary care physician. Difficulties related to this disclosure are counterbalanced by benefits for both patient and families.

Complete or partial return to work (RTW) succeeds in around 40% of TBI and 25% of stroke patients. Positive factors include: (1) post-traumatic amnesia, hospitalization length, age, race, pretraumatic work and socio-educational status, quality of life, (2) premorbid intellectual level, learning, language and attentional, (3) social cognition and deficit's awareness and (4) absence of behavioural impairment. In stroke, RTW is associated with normal neurological and cognitive/communication abilities. Vocational rehabilitation necessitates: (1) cognitive retraining (speed, visuospatial skills and memory), (2) behavioural approach (compensation, organization, abstraction) and (3) adaptation of work profile. Case management models, with early intervention, continuity of care and coordination, increase twofold partial or complete adapted RTW.

Primary headaches, whose aetiologies cannot be identified by current diagnostic methods, represent the most frequent headaches and must be distinguished from secondary or symptomatic headaches, e.g. related to traumatic, vascular, inflammatory or neoplastic processes. Only an appropriate treatment will meet the expectations of patients, for who even a mild headache may generate important fears and handicaps. Medical history and physical examination form the basis for targeting the right diagnosis before any biological or radiological testing. The article presents guidelines implemented at the Geneva University Hospitals by the Pain Network of the institution. Therapeutic modalities and recommendations concerning the need for specialized assessments are presented to provide a framework in both emergency situation and long-term care.

Primary headaches, whose aetiologies cannot be identified by current diagnostic methods, represent the most frequent headaches and must be distinguished from secondary or symptomatic headaches, e.g. related to traumatic, vascular, inflammatory or neoplastic processes. Only an appropriate treatment will meet the expectations of patients, for who even a mild headache may generate important fears and handicaps. Medical history and physical examination form the basis for targeting the right diagnosis before any biological or radiological testing. The article presents guidelines implemented at the Geneva University Hospitals by the Pain Network of the institution. Therapeutic modalities and recommendations concerning the need for specialized assessments are presented to provide a framework in both emergency situation and long-term care.

Behavioral changes occurring in patients affected by multiple sclerosis (MSI are often neglected by physicians but are actually part of the clinical spectrum of the disease. In addition, they are known to be responsible for a decline in the quality of life of MS patients. Recently, there has been a growing interest to investigate changes in the emotional experience of MS patients and their decision making, showing that the ability to take advantageous decisions was altered in MS. This paper reviews existing data on this topic.

Behavioral changes occurring in patients affected by multiple sclerosis (MSI are often neglected by physicians but are actually part of the clinical spectrum of the disease. In addition, they are known to be responsible for a decline in the quality of life of MS patients. Recently, there has been a growing interest to investigate changes in the emotional experience of MS patients and their decision making, showing that the ability to take advantageous decisions was altered in MS. This paper reviews existing data on this topic.

The assessement of behavior is common part of the neurological examination. This article reviews the behavioral and mood manifestations in four classical syndroms: Epilepsy, stroke, Parkinson's disease and multiple sclerosis.

The development of software facilitating decision taking is becoming more frequent, due to the growing need of reactivity and competitiveness within companies. Such software is called Decision Support Systems (DSS). However, 80% of decision making projects fail to satisfy user requirements, and 40% fail to help decision making. The recent works of methods bound to DSS define their schemes from the user requirements and the source systems. However, they can not represent all specificities of the DSS. Moreover, they rely on specific models representing only data, the dynamic aspect of DSS being largely ignored. Thus, none of these models is accepted neither by the researchers nor the practitioners. In a first time, we will propose a method which takes into account the DSS specificities, including those related to actor requirements. We will analyse the static and dynamic aspects of DSS as defined by structures specifying the requirements. Those will be represented via a model close to the multidimensional vision of the data by users. From this modelling, we will automatically choose the DSS architecture adapted to a project. This architecture relies on many kinds of decisional modules, some of which are multidimensional. Therefore, we propose a multidimensional model generalising the existing models, thus also aiming to fix the lack of an accepted standard model. In a second time, we propose a catalogue patterns which capitalize upon our development method. This catalogue helps a systematic later reuse of our method. In one part, the pattern context formalisation helps searching for such a pattern since the conditions of its usability and those upon which another pattern is required are formally specified. In a second part, the integrated documentation management into pattern representation helps improving the reliability of the systems being developed. Then, to facilitate the rapid development of DSS by reusing our patterns, we have developed a tool called eBIPAD (Electronic Business Intelligence Patterns for Analysis and Design) to manage, organize and reuse these patterns. This tool is directed to patterns administrators and to the decisional designers. We have been able to validate our proposals through consultancy missions, realized within the ID6 company which is specialized in decision taking, through a french corporate PhD grant (CIFRE).; Face au besoin croissant de réactivité et de compétitivité des organisations, les développements de systémes qui facilitent la prise de décision se sont démocratisés. Ces systèmes sont des «systèmes d'information décisionnels» (SID). Cependant, 80% des projets décisionnels ne parviennent pas à satisfaire les besoins des utilisateurs et 40% d'entre eux échouent à faciliter la prise de décision. Les récentes propositions de méthodes liées aux SID définissent leur schéma à partir des besoins des utilisateurs et des systèmes sources. Néanmoins, elles ne permettent pas de représenter toutes les spécificités des SID. De plus, elles reposent sur des modèles spécifiques ne représentant que les données, l'aspect dynamique des SID n'étant que peu abordé. Aucun de ces modèles n'est donc reconnu par les chercheurs et les industriels. Dans un premier temps, nous proposons une méthode qui prend en compte les spécificités du SID ainsi que celles des besoins de ces acteurs. Nous analysons l'aspect statique et l'aspect dynamique du SID d´efinis à partir de structures spécifiant les besoins et nous les représentons via un modèle proche de la vision multidimensionnelle des données par les utilisateurs. A partir de cette formalisation, nous guidons suivant un processus automatique le choix de l'architecture du SID adaptée à un projet. Cette architecture repose sur plusieurs types de modules décisionnels dont certains sont multidimensionnels. Nous proposons donc un modèle multidimensionnel généralisé à partir des propositions existantes, visant par la même de répondre à ce manque de modèle standard. Dans un second temps, nous proposons un catalogue de patrons qui capitalise notre méthode de développement. Ce catalogue favorise la réutilisation systématique de notre méthode : d'une part, la formalisation du contexte d'un patron facilite sa recherche car les conditions dans lesquelles il est utilisable et celles dans lesquelles il requiert un autre patron sont formellement spécifiées, d'autre part, la gestion intégrée de la documentation dans sa représentation contribue à améliorer la fiabilit´e des systèmes développés. Enfin, pour faciliter le développement rapide de SID par réutilisation de nos patrons, nous avons développé un outil, appelé eBIPAD (Electronic Business Intelligence Patterns for Analysis and Design), de gestion de ces patrons avec des fonctionnalités d'organisation et de réutilisation. Cet outil est dédié aux administrateurs des patrons et aux concepteurs décisionnels. Nous avons pu valider nos propositions au cours des missions que nous avons menées au sein de la société, I-D6, spécialisée dans le décisionnel, et ce, dans le cadre d'une collaboration CIFRE.

Fatigue is a complex, subjective experience, frequent in multiple sclerosis (MS) and stroke patients. The tiredness these patients experience can take on many features depending not only on the cerebral location of the lesions and mood aspects, but also on the pathophysiology of the disease. Thus, it is reasonable to expect that fatigue may have different implications in MS and stroke. The aim of the present work was to compare fatigue syndrome in these two populations. Patients were matched for handicap.Seventy-nine stroke and 39 MS outpatients were included with the following inclusion criteria: i) patients with possible or relapsing-remitting MS with an Expanded Disability Status Scale (EDSS) score2.5, disease duration6 years, and stable medical condition for at least 6 weeks; ii) stroke patients with mild neurological impairment, i.e. scoring3 at the National Institute of Health Stroke Scale (NIHSS) one year after stroke; iii) absence of functional impairment (Barthel index=100) and similar negligible handicap (Rankin scale2 for both groups); no or mild cognitive deficit; iv) neither DSMIV criteria of depression, nor significant anxious/depressive symptoms (Hospital Anxiety and Depression scale; HAD; score8) in both groups. The Fatigue Assessing Instrument (FAI) was used to assess fatigue.Twenty-nine percent of stroke and 46 p. cent of MS patients had a significant score on the FAI (p0.05). Multiple regression analysis using groups, gender and age as factors showed a group effect in 3 out of 4 subscales: MS patients scored higher than stroke patients mainly for psychic impact (4.86 vs. 3.28), but also for severity (mean 3.86 vs. 2.97) and specificity (4.36 vs. 3.32). Response to rest (5.36 vs. 6.06) only tended to be better in the stroke group. In the subpopulation with significant fatigue scores, psychic impact was more elevated in the MS group. The functional consequence of fatigue in physical, professional and social activities were similar.Fatigue was more severe in MS than stroke patients, independently of disability. The most significant factor in the MS group was the psychic impact, reflecting impaired motivation, concentration and irritability, despite the absence of depression. However, subjective consequences of fatigue on work, family and leisure activities were comparable in both groups.

Neurodegenerative and cerebrovascular diseases have been related for more than a century. Epidemiological data show that main vascular risk factors are also risk factors for Alzheimer disease. Experimental evidences demonstrate that some of those risk factors accelerate the progress of Alzheimer lesions, mainly by acting on the amyloid cascade. Recent advances in understanding the basic mechanisms of CADASIL and familial amyloid angiopathy reveal that these forms of vascular dementias are degenerative disease of brain vessels. Modern neuroimaging techniques will allow to better understand relations between symptomatic strokes, silent infarcts, leukoaraiosis, microbleeds and degenerative pathology before the stage of dementia.

Neurodegenerative and cerebrovascular diseases have been related for more than a century. Epidemiological data show that main vascular risk factors are also risk factors for Alzheimer disease. Experimental evidences demonstrate that some of those risk factors accelerate the progress of Alzheimer lesions, mainly by acting on the amyloid cascade. Recent advances in understanding the basic mechanisms of CADASIL and familial amyloid angiopathy reveal that these forms of vascular dementias are degenerative disease of brain vessels. Modern neuroimaging techniques will allow to better understand relations between symptomatic strokes, silent infarcts, leukoaraiosis, microbleeds and degenerative pathology before the stage of dementia.

Neuropsychology is a scientific discipline, born in the XIX century, and bridges the fields of neurology and psychology. Neuropsychologists apply scientific knowledge about the relationship between brain function and mental performances. The major clinical role of a neuropsychological evaluation is to help to establish medical and functional diagnosis in patients (adults or infants) with different neurological pathologies such as stroke, traumatic brain injury, dementia, epilepsy.... Such analysis necessitates accurate observation of behaviour and administration of tests of mental abilities (e.g. language, memory...). Test results can also help to clarify the nature of cognitive difficulties and to support the formulation of plans for neuropsychological therapy and functional adjustment in every day life.

A long-lasting histological study on muscle and cutaneous-subcutaneous biopsies allowed certain observations of microvalves in venules with a diameter ranging from 80 to 200 micron. Venular leaflets originate from the vein as extroflection of the intima, made by a single layer of endothelial cells. In the patient affected by severe chronic venous insufficiency the valvular leaflets appear thickened while the wall of the venule presents sclero-hyalinotic alterations. The presence of microvalves in venules suggests a role of their incontinence in the venous insufficiency. Considering that the venular leaflets are made just by endothelial cells, a primary pathogenetic role has to be achieved to the endotheliopathy in the genesis of venous insufficiency.

Chest deformation due to cardiac activity can be studied with the use of techniques based on Moiré principle. The shadow technique allows to obtain well contrasted fringes, whereas the technique of projected Moiré allows an easier taking of camera pictures. The fringes in this case, although less contrasted, allow to recognize level differences of the order of 0.17 mm with a network of 20 traits/mm in the present configuration of our material. The best criteria of registration have been set up after the study of 10 young subjects. In the presented case topographic measurements allowed a quantitative evaluation of the apical impulse. The telesystolic image after treatment allowed a tridimensional reconstruction of chest deformation.

L‘impact des maladies neurologiques sur notre fonctionnement mental n'a été souvent mesurée que par des évaluations cognitives. La pratique clinique, toutefois, nous démontre que cet impact intègre également la modification affective, les relations interpersonnelles et la capacité d'évaluer nos décisions. Cette thèse consiste d'une recherche originale sur la cognition sociale et d'une revue systématique sur la capacité de prise de décision dans les personnes touchées par SEP. Ces domaines intègrent des fonctions cognitives et affectives. Dans les deux domaines, des déficits étaient présents et partiellement indépendants des autres fonctions mesurées. Ceci indique la nécessité d'avoir des tests cliniques qui incluent les changements comportementaux en plus des aspects qui sont traditionnellement testés. Une démarche pourrait être d'extraire des différents tests les sous-tests les plus sensibles et les intégrer à l'examen clinique de routine. Des examens plus complets pourraient aussi aider à évaluer plus précisément le gain des options thérapeutiques.

Cette étude a pour objectif d'analyser chez des patients bilingues aphasiques après un AVC, l'influence de l'âge d'acquisition de la deuxième langue (L2) sur la syntaxe. Douze bilingues tardifs (parlant Français en L2 et soit Allemand, Italien ou Espagnol en L1) ont été évalués au moyen des batteries MAST ou BAT pour l'aphasie et par une tâche de jugement syntaxique auditive. Les scores globaux d'aphasie ont été similaires en L1 et L2; Onze patients sur 12 ont des scores langagiers équivalents. Dans la tâche syntaxique, quatre patients présentent une performance plus basse en L2 qu'en L1 ; les quatre ont un ramollissement cérébral exclusivement ou partiellement pré-rolandique. Cette étude pilote suggère que chez les bilingues aphasiques, la syntaxe peut être plus sévèrement atteinte en L2, en particulier après une lésion antérieure. L2 et L1 pourraient donc utiliser les mêmes réseaux neuronaux pour le traitement syntaxique.