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International audience; The purpose of this article is to describe complex psychiatric disorders, to recall “minimal classical” explorations in psychiatry, to describe the concept of “complex psychiatric disorders” and to propose a systematized method of exploration.Some organic diseases are well known for their links with psychiatric disorders (manic syndrome and hyperthyroidism, depressive syndrome and corticotropic insufficiency, anxiety disorder and heart disease, etc.).Many other neurological, autoimmune, metabolic, paraneoplastic or endocrine pathologies can have essentially psycho-behavioral manifestations before being neurological or systemic.A large number of factors (nutritional, toxic, immunological, etc.), often ignored, influence the links between organicity and psychiatric pathologies.It is necessary to optimize the medical management of these patients in whom the psychiatric diagnosis masks a curable organo-psychiatric cause.; Cet article a pour objectifs de décrire des troubles psychiatriques complexes, de rappeler les explorations « classiques minimales » en psychiatrie, de décrire le concept de « troubles psychiatriques complexes » et de proposer une méthode d’exploration systématisée.Certaines pathologies organiques sont bien connues pour leurs liens avec les troubles psychiatriques (syndrome maniaque et hyperthyroïdie, syndrome dépressif et insuffisance corticotrope, trouble anxieux et maladie cardiaque, etc.).De nombreuses autres pathologies neurologiques, auto-immunes, métaboliques, paranéoplasiques ou endocriniennes peuvent avoir des manifestations essentiellement psycho-comportementales avant d’être neurologiques ou systémiques.Un grand nombre de facteurs (nutritionnels, toxiques, immunologiques, etc.), souvent ignorés, exercent une influence sur les liens existants entre organicité et pathologies psychiatriques.Il est nécessaire d’optimiser la prise en charge médicale de ces patients chez qui le diagnostic psychiatrique masque une cause organo-psychiatrique curable.

International audience; Objective To assess the efficacy of tumour necrosis factor-α (TNF-α) inhibitors used as steroid-sparing monotherapy in central nervous system (CNS) parenchymal sarcoidosis. Methods The French Multiple Sclerosis and Neuroinflammation Centers retrospectively identified patients with definite or probable CNS sarcoidosis treated with TNF-α inhibitors as steroid-sparing monotherapy. Only patients with CNS parenchymal involvement demonstrated by MRI and imaging follow-up were included. The primary outcome was the minimum dose of steroids reached that was not associated with clinical or imaging worsening during a minimum of 3 months after dosing change. Results Of the identified 38 patients with CNS sarcoidosis treated with TNF-α inhibitors, 23 fulfilled all criteria (13 females). Treatments were infliximab (n=22) or adalimumab (n=1) for a median (IQR) of 24 (17–40) months. At treatment initiation, the mean (SD) age was 41.5 (10.5) years and median (IQR) disease duration 22 (14–49.5) months. Overall, 60% of patients received other immunosuppressive agents before a TNF-α inhibitor. The mean (SD) minimum dose of steroids was 31.5 (33) mg before TNF-α inhibitor initiation and 6.5 (5.5) mg after (p=0.001). In all, 65% of patients achieved steroids dosing

International audience; No abstract available

International audience; Introduction: Familial Mediterranean fever (FMF) is the most frequent monogenic autoinflammatory disorder; and leads to the uncontrolled production of interleukin (IL)-1β. Multiple sclerosis (MS) is an inflammatory disease of the central nervous system; and its development seems to be partly correlated with IL-1β levels. It is hypothesized that FMF could be associated with MS. We aim to describe the features of patients displaying both diseases and to investigate the MEFV mutation rate in MS patients.Methods: Patients with definite MS were retrieved from the cohort of FMF patients in the Reference Center for Rare Auto-inflammatory Diseases and Amyloidosis (CEREMAIA). We also performed a systematic literature review of articles from PubMed that were published from 1990 to 2020.Results: Twenty-four patients were included in the case series: five patients (1.3%) from our cohort of 364 and 19 patients from the literature. The sex ratio was 2:1. The mean age at diagnosis of FMF was 19 years old; and that for MS was 29 years old. Seven studies investigating the MEFV mutation rate in MS patients were included. Three studies found a higher mutation rate in MS patients than in the control group.Conclusion: FMF and MS features were comparable to those of patients with unrelated diseases; and MEFV mutation carriage was not positively correlated with MS. However; MS prevalence in FMF patients was higher than was expected in a healthy population. To a lesser extent; FMF prevalence in MS patients was higher than expected in a healthy population and the difference might not be significant. These data suggest that FMF could be associated with MS; and further studies are needed to investigate a potential causal association.

ObjectiveTo study blood anti-Aβ antibodies in the context of spontaneous inflammatory or hemorrhagic CAA manifestations, which are similar to complications occurring after monoclonal anti-Aβ antibody immunotherapies.MethodsIn this case-control study, serum anti-Aβ antibody isotype, concentration, avidity, and reactivity toward soluble or fibrillary Aβ1-40 and Aβ1-42 isoforms were assessed using an ELISA-based multiplex analysis. Anti-Aβ serologic patterns were defined in CAA and CAA subgroups using multivariable logistic regression analyses.ResultsFourty-one healthy aged controls and 64 CAA patients were recruited: 46 with hemorrhagic features (CAA-he) and 18 with CAA-related inflammation (CAA-ri). As compared to controls, the most striking features of CAA-related serological profiles were the following: i) both CAA-he and CAA-ri patients displayed lower binding diversity of anti-soluble Aβ1-40 IgM; ii) CAA-he patients displayed higher anti-soluble Aβ1-40 / fibrillary Aβ1-42 IgG4 concentrations ratio and higher anti-soluble Aβ1-42 IgG4 and IgA avidity; iii) CAA-ri patients displayed higher binding diversity of anti-soluble Aβ1-40 IgG3 and higher anti-fibrillary/soluble Aβ1-42 IgG4 dilution curve steepness ratio.ConclusionThis proof-of-concept study revealed anti-Aβ antibody variations in CAA patients, some of which were associated to CAA clinical phenotypes, unveiling pathophysiological insights regarding CAA-hemorrhagic and inflammatory related events.

Primary Sjögren's syndrome (pSS) is a common systemic autoimmune disease characterised by exocrinopathy resulting in dryness of the mouth and eyes, unexplained fatigue and diffuse pain. Neurological involvement is uncommon in pSS, involving the central nervous system in 2-5% of cases and more frequently the peripheral nervous system in 5-15% of cases. The diagnosis of pSS is to be considered when confronted with symptoms such as mouth and eye dryness, fatigue and pain, the most frequent of pSS symptoms. Objective measures of oral and eye dryness may help assert the diagnosis of pSS, as well as ACR/EULAR criteria. Differential diagnoses have to be excluded in patients exhibiting neurological symptoms, such as cryoglobulinaemic vasculitis or multiple sclerosis, before considering a neurological involvement specific to pSS. The treatment of these neurological manifestations takes into account different parameters, such as the presence of cryoglobulinaemic vasculitis, the severity of the symptoms, a rapidly progressing evolution and the failure of previous symptomatic treatments.

SARS-Cov2 is responsible for COVID-19 that can cause severe respiratory illness, and which can be associated with ischaemic stroke (IS).1 The objectives of our comparative cross-sectional study were to describe the characteristics of consecutive patients with IS and COVID-19, to compare them to COVID-19-negative IS patients admitted within the same period and to attempt to identify a specific pattern of IS in COVID-19. We conducted a comparative cross-sectional study at two tertiary stroke units, Pitie-Salpetriere and Saint-Antoine Hospitals, between March 20 and April 20 2020. Cases and controls were all consecutive adult patients hospitalised for recent IS, confirmed on neuroimaging. Cases were diagnosed with COVID-19 if a nasopharyngeal reverse transcription (RT-PCR) test for SARS-CoV-2 (Allplex 2019-nCoV Assay, Seegene) was positive and/or if a chest CT-scan was typical for COVID-19. Exclusion criteria were diagnoses of transient ischaemic attack, haemorrhagic stroke or stroke secondary to cerebral venous thrombosis. We collected demographic data, cardiovascular risk factors, neurological data, blood test results, in-hospital treatments and discharge outcomes. After reviewing the available workup for each patient (vascular imaging of cerebral and cervical arteries and cardiac evaluation including a 12-lead ECG, 48 hours continuous ECG monitoring and transthoracic echocardiogram), aetiology of IS was classified according to ASCODphenotyping (A: atherosclerosis; S: small-vessel disease; C: cardiac pathology; O: other causes; D: dissection). Fisher’s exact test and Wilcoxon-Mann-Whitney test were used to compare cases and controls for categorical and continuous variables respectively. P­ values

Acute cerebrovascular ischemic events are a rare and severe complication of giant cell arteritis (GCA). We aimed to determine the prevalence of GCA-related stroke, the overall survival and the relapse-free survival in patients with GCA. A multicentric retrospective analysis was performed on 129 patients with GCA diagnosed between September 2010 and October 2018 in two University Hospitals. Among 129 GCA patients, 18 (16%) presented an acute ischemic cerebrovascular event. Patients with stroke were older (83 [67-96] years versus 76 [58-96]; p = 0.014) and more frequently males (61% versus 30%; p = 0.014) than those without stroke. The frequency of anterior ischemic optic neuropathy was higher in patients with stroke (n = 6, 33%) than patients without stroke (n = 12, 11%)(p = 0.02). Overall survival was significantly decreased in GCA patients with stroke (4.4 months), comparatively to patients without stroke (221.7 months; log rank test = 0.006). The 3-years relapse-free survival was decreased in patients with stroke (8.42 versus78.0 months; log rank = 0.0001), as well as the time with sustained remission (78 versus 139 months; log rank test = 0.0004). This study shows the prevalence and risk factors of ischemic stroke in GCA.

International audience; A 22-year-old HIV-negative man was admitted to the intensive care unit for generalized seizures. The patient’s family reported a 1-month history of asthenia and intermittent confusion. Clinical examination revealed isolated inappropriateness of behavior related to a frontal lobe syndrom, without any neck stiffness or neurologic deficit.

Familial Mediterranean fever (FMF) causes recurrent episodes of fever and painful serositis. It has been suggested that FMF can cause recurrent aseptic meningitis (RAM). Due to the rarity of both diseases, this claim cannot be assessed with epidemiological methods. We therefore decided to perform a systematic review of the literature to assess the number and validity of published case reports.Medline, Embase, Pascal, Web of Science and the proceedings of relevant conferences were searched. Two independent investigators selected reports asserting RAM in FMF patients, abstracted data and rated the strength of evidence with a custom tool designed to assess: (a) the diagnosis of FMF; (b) the diagnosis of RAM; and (c) the link between FMF and RAM. A causal link was supported by (i) evidence of inflammation and/or clinical FMF features during episodes of RAM; (ii) effectiveness of colchicine to prevent further bouts of meningitis; and (iii) the exclusion of other causes of RAM.Among 944 retrieved references, 917 were rejected by title and abstract screening and 15 after full text review. The strength of evidence of 12 alleged cases of RAM due to FMF was assessed. FMF was unsupported in 4 cases and RAM in 3 further cases. Four of the 5 remaining cases did not provide adequate evidence to support a causal relationship between FMF and RAM.The possibility of RAM due to FMF is poorly supported by a single fairly documented case report that does not, however, meet current diagnostic standards.

Piault Marc Henri, Dreyfus-Gamelon Simone, Ducros Albert, Bensa Alban, Tubiana Marie-José, Baroin Catherine, Meillassoux Claude, Capron Jean, Terray Emmanuel, Morin Françoise, Condominas G. L' implication du chercheur de terrain avec la société d' accueil Débat de l'Assemblée générale de l'A.F. A. du 25 mars 1987. In: Bulletin de l'Association française des anthropologues, n°29-30, Septembre-décembre 1987. L'ethnologue et son terrain : Tome I, sous la direction de Suzanne Lallemand, Josiane Massard et Danièle Kintz. pp. 13-41.

Opening ParagraphOn a souvent répété des cultures négro-africaines qu'elles étaient imprégnées de spiritualité sinon de religiosité; pourtant, comme le remarquait dans un récent article Madame Calame-Griaule: ‘il serait faux de croire que le facteur religieux y joue un rôle essentiel’; il se situe en réalité sur le même plan que les autres manifestations de la vie sociale; il concourt à la construction de cet ensemble fonctionnel que constitue toute culture. C'est dans cette perspective que nous voudrions tenter d'examiner comment la religion bwa – dont les manifestations les plus élaborées et les plus valorisées s'expriment dans l'organisation et le fonctionnement de la société du do – s'intègre dans un complexe institutionnel précis dont elle n'est pas seulement, à certains égards, le reflet, mais l'un des rouages essentiels.

Capron Jean. Quelques notes sur la société du do chez les populations Bʷa du cercle de San. In: Journal de la Société des Africanistes, 1957, tome 27, fascicule 1. pp. 81-129.