Search

La question traitée dans cet article porte sur le monde d’après la pandémie… Représente-t-elle un moment décisif qui va nous faire basculer vers une société plus responsable sur les plans sociaux et environnementaux ? De nouvelles habitudes et de nouveaux comportements responsables vont-ils se mettre en place de manière durable ? Pour répondre à ces enjeux, cet article mobilise des théories plurielles associées aux changements d’habitudes. Des préconisations s’adressant autant aux entreprises, qu’aux décideurs publics ou citoyens sont proposées pour dessiner les contours d’un après-Covid-19 socialement et écologiquement plus acceptable.

ATYPICAL PARKINSONIAN SYNDROMES Idiopathic Parkinson's disease is the most common cause of parkinsonism, but in almost 40 % of cases, parkinsonism is due to other causes. The diagnosis of atypical parkinsonian syndromes remains difficult at the early stage. Parkinson's syndrome is associated with other symptoms called «red flags». These red flags need to be identified during the clinical examination. Unlike Parkinson's disease, dopaminergic treatment are slightly effective on motor symptoms. The prognosis is worst, with a faster progression. The life expectation is reduced compared to Parkinson's disease. Diagnosis certainty, given by anatomopathology, is not available during the patient's lifetime. Advances in functional imaging improve diagnosis accuracy. Clinical course answers diagnosis uncertainties in a few month or years. The follow up is multidisciplinary. No treatment is currently available., Competing Interests: C. Beal déclare n’avoir aucun lien d’intérêts. F. Durif n’a pas fourni de déclaration de liens d’intérêts.

Background and Purpose: Deep brain stimulation (DBS) is an effective treatment of movement disorders and psychiatric diseases. However, this surgery is still time consuming and associated with complications, among which we aimed to identify non-stimulo-induced adverse effects. Hence, we retrospectively systematically analyzed patients operated on, at our institution, using magnetic resonance imaging (MRI) direct anatomic mapping., Methods: One hundred and seventy-five patients (184 surgeries) were performed between 1994 and 2008, for Parkinson's disease, essential tremor, dystonia and obsessive compulsive disorder. Primary anatomic targets were the subthalamic region, the intern pallidum and the thalamus. Final electrode positioning was adjusted according to intraoperative neuron recordings and acute stimulation tests. All surgically related adverse effects were collected. Life threatening or new non-planed surgery was considered as severe adverse effects., Results: Adverse effects occurred 10 times (5.4%) during MRI acquisition, 24 times (13%) with five serious (2.7%) including one1 death (0.5%) during electrodes implantation and 17 times (9.2%) with four serious (2.2%) during neuropacemaker implantation. Electrodes were repositioned in six cases (five patients, n=3.4%)., Conclusion: DBS efficiency is recognized however the significant incidence of adverse effects should prompt us to improve the procedures., (Copyright © 2012. Published by Elsevier Masson SAS.)

Parkinson's disease is a neurodegenerative disorder clinically characterized by motor impairments (tremor, bradykinesia, rigidity and postural instability) associated or not with non-motor complications (cognitive disorders, dysautonomia). Most of patients loose weight during evolution of their disease. Dysregulations of hypothalamus, which is considered as the regulatory center of satiety and energy metabolism, could play a major role in this phenomenon. Deep brain stimulation of the subthalamic nucleus (NST) is an effective method to treat patients with advanced Parkinson's disease providing marked improvement of motor impairments. This chirurgical procedure also induces a rapid and strong body weight gain and sometimes obesity. This post-operative weight gain, which exceeds largely weight lost recorded in non-operated patient, could be responsible of metabolic disorders (such as diabetes) and cardiovascular diseases. This review describes body weight variations generated by Parkinson' disease and deep brain stimulation of the NST, and focuses on metabolic disorders capable to explain them. Finally, this review emphasizes on the importance of an adequate nutritional follow up care for parkinsonian patient., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

The common perception that Parkinson's disease patients tend to be depressed, anxious, apathetic and harm-avoiding has currently been challenged by the recognition that they can also exhibit a hedonistic, novelty-seeking personality. Thus, Parkinson's disease patients may indulge in their passions in an irresponsible and disinhibited manner, and engage in repetitive, compulsive behaviors that may be harmful and destructive to their social or professional lives. The dopamine dysregulation syndrome includes hypersexuality, pathological gambling, and compulsive shopping; it is associated with addiction to dopaminergic medication. However, not all behavioral changes are necessarily accompanied by a dopaminergic addiction. After antiparkinson treatment is initiated, patients enter a 'honeymoon period' during which changes in mood and behavior reflect a return to the patients' premorbid personality. The increased motivation and higher level of activity in professional as well as leisure activities are considered positive changes by both the patients and their relatives. With prolonged and increased dopaminergic treatment, these positive behavioral changes can become excessive and evolve into nocturnal hyperactivity and stereotyped, repetitive and time consuming behaviors which ultimately disorganize the patient's everyday routine and herald behavioral addictions. These drug-induced behavioral changes are under-appreciated by neurologists and under-reported by the patients who neither complain about the behaviors nor understand the relationship between motivated behavior and dopaminergic medication. For these reasons, we propose a new scale for the assessment of behavior and mood to quantify and track changes related to Parkinson's disease, to dopaminergic medication, and to non-motor fluctuations. This scale is based on the concept of hypo- and hyperdopaminergic mood and behavior. The scale consists of 18 items addressing non-motor symptoms, grouped in four parts: general psychological evaluation, apathy, non-motor fluctuations and hyperdopaminergic behaviors. The rating in five points (0-4 from absent to severe) is carried out during a semi-structured interview. Open-ended questions introduce each item, allowing patients to express themselves as freely as possible. Close-ended questions permit the rating of severity and intensity. This new instrument can be used by psychologists, psychiatrists or neurologists familiar with Parkinson's disease. Designed to detect changes in mood and behavior of Parkinson's disease patients resulting either from the disease or its treatment, this tool can be used in conjunction with the neurocognitive evaluation, to help tailor the treatment of motor and non-motor symptoms to each individual's needs.

It has been known for more than 30 years that the efficiency of the dopaminergic treatments can wear off. Currently, motor fluctuations and especially non-motor fluctuations (dysautonomic, cognitive/psychiatric or sensory/pain) remain often underdiagnosed in the first years of treatment. The patient self-questionnaire used in this study has been developed and validated in the United States. Its French version has been tested in daily practice in a study with 938 Parkinson's patients followed-up by movement disorders specialists. Use of this self-assessment patient card has resulted in the detection of fluctuations in 49% of patients, considered nonfluctuating by neurologists after a clinical assessment. The impact of these fluctuations unknown at first is significant, since these motor and/or non motor symptoms are considered troublesome or perturbing for daily life activities by 70% of fluctuating patients. The investigators have recognized the usefulness of this self-assessment in order to detect fluctuations in 81% of fluctuating patients, which lead them to modify the treatment in 76% of them.

Introduction: Between 4 and 15% of solid cancers are associated with carcinomatous meningitis ant its unfavorable prognosis. The clinical presentation of neoplastic meningitis typically associates cerebral signs, cranial nerve involvement, and medullary or radicular symptoms., Observation: We report a case of a 58-year-old woman, with a history of breast cancer in remission since 8 years, who presented an acute paraparesia and a pure motor deficit of the left arm. This diffuse lower motor neuron disease was the inaugural sign of carcinomatous meningitis., Conclusion: The diagnosis of cacinomatous meningitis is based on medullar MRI and lumbar puncture. In same cases, clinical signs are limited to a pure diffuse lower motor neuron disease.

Chronic dopamine treatment usually provides partial and temporary improvement of extrapyramidal signs in about 40p.cent of the patients with multiple system atrophy. Exceptionally, dopamine agonists may provide a significant and persistent improvement in progressive supranuclear palsy. For patients with Lewy body dementia, levodopa often provides a significant improvement of the extrapyramidal syndrome in about 70p.cent of the treated patients. Dopamine treatment generally has no effect on secondary extrapyramidal syndromes caused by vascular parkinsonism or neuroleptics. Antiparkinsonian treatment can cause several complications, particularly degenerative parkinsonian syndromes with an increased frequency of cognitive disorders and dysautonomia. Consequently, antiparkinsonian agents should only be proposed within the framework of a differential diagnosis between parkinsonism and idiopathic Parkinson's disease then continued only if the risk/benefit ratio, systematically evaluated for each patient, is favorable.