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INTRODUCTION: Complications following COVID-19 are starting to emerge; neurological disorders are already described in the literature. CASE REPORT: This case is about a 20-year old male with a severe COVID-19, hospitalized in a Reanimation and Intensive Care Unit with an Acute Respiratory Distress Syndrome, thromboembolic complication and secondary bacterial infection. This patient had a non-specific neurological disorder with a pseudobulbar palsy, (MRI, ENMG and lumbar puncture were normal), associated 4 months later with persistent left shoulder motor deficit and respiratory failure. Respiratory and neurological check-up led to a diagnosis of the Parsonage-Turner syndrome or neuralgic amyotrophy affecting C5-C6 nerve roots, the lateral pectoral and phrenic nerves at the origin of the scapular belt, amyotrophy and left diaphragm paralysis. CONCLUSIONS: This case shows that persistant dyspnoea after COVID 19 infection should lead to a search for a diaphragmatic cause which is not always the result of Reanimation Neuropathy but may also indicate a neuralgic amyotrophy. It is the fourth case of neuralgic amyotrophy following COVID-19. This brings the medical community to consider the risk of diaphragm paralysis apart from critical illness polyneuropathy. Respiratory muscle evaluation and diaphragmatic ultrasound should be considered in case of persistent dyspnoea.

The aim of our prospective single-center study was to assess the loss of bone mineral density (BMD) in the year following stroke with hemiplegia. We evaluated functional disability and bone mineral density (BMD) in 18 patients immediately following and at 1 year of stroke with hemiplegia. The most significant variation in BMD concerns the femoral neck on the hemiplegic side: -0.0551±0.0548g/cm

Resume Introduction La prise en charge chirurgicale des escarres perineales fait appel a de nombreux lambeaux fascio-cutanes ou musculo-cutanes. Ils permettent d’assurer la couverture et le comblement de la grande majorite des escarres rencontrees chez le blesse medullaire. Dans de rares cas, ces solutions classiques sont depassees : il est alors necessaire de faire appel a des solutions chirurgicales sur mesure, adaptees au patient. Nous presentons ici un cas de lambeau sur mesure de membre inferieur en couverture d’escarres perineales confluentes. Patient et methode Notre patient, âge de 49 ans, paraplegique depuis 21 ans, presentait des escarres ischiatiques et trochanteriennes bilaterales (luxation tete-col), pubienne inferieure. La solution chirurgicale retenue a ete la suivante : realisation d’un lambeau total de cuisse droite pour la couverture et le comblement de l’hemi-bassin droit ; associe au prelevement en ilot d’un lambeau musculo-cutane de face posterieure de jambe droite pour la couverture et le comblement de l’escarre trochanterienne gauche. Resultat L’intervention a dure 6 h 30 et a necessite une transfusion massive (culots globulaires et plasma). L’antibiotherapie a ete adaptee aux prelevements. Les suites operatoires ont ete simples, avec une cicatrisation stable obtenue en trois semaines. Discussion Le sacrifice d’un membre inferieur pour la couverture d’escarre geante perineale est une solution chirurgicale extreme, a reserver pour des patients ayant parfaitement compris les enjeux de cette operation de la derniere chance. Une bonne connaissance de l’anatomie vasculaire est le pre-requis indispensable a sa realisation, et permet de lever des lambeaux sur mesures. Le succes de cette intervention est etroitement lie a la collaboration avec l’equipe de reeducation (education therapeutique adaptee [transferts et positionnement]).

International audience; CASP specifically assesses post-stroke cognitive impairments. Its items are visual and as such can be administered to patients with severe expressive aphasia. We have previously shown that the CASP was more suitable than the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in aphasic patients. Our objective was to compare the above scales in non-aphasic stroke patients, and assess to what extent the solely visual items of the CASP were problematic in cases of neurovisual impairments.METHODS:Fifty non-aphasic patients admitted to Physical Medicine and Rehabilitation (PM&R) units after a recent left- or right-hemisphere stroke were evaluated with the CASP, MMSE and MoCA. We compared these three scales in terms of feasibility, concordance, and influence of neurovisual impairments on the total score.RESULTS:Twenty-nine men and 21 women were included (mean age 63 ± 14). For three patients, the MoCa was impossible to administer. It took significantly less time to administer the CASP (10 ± 5 min) than the MoCA (11 ± 5 min, P=0.02), yet it still took more time than MMSE administration (7 ± 3 min, P

Resume Objectifs L’evaluation de la fonction renale est essentielle dans le suivi des patients ayant une vessie neurologique. L’objectif de cette etude etait de determiner si l’echographie renale permettrait a la fois d’evaluer la morphologie de l’appareil urinaire et la fonction renale. Methode Dans une etude retrospective, tous les patients suivis pour une vessie neurologique ont ete inclus, quelle que soit leur pathologie neurologique. La fonction renale etait estimee par la clairance de la creatinine sur 24 heures (Cl24 h), examen de reference chez les patients neurologiques, le debit de filtration glomerulaire par la formule MDRD simplifiee (MDRDs) et la formule CKD-EPI creatinine, et nous avons releve les anomalies renales detectees a l’echographie renale. Resultats Cent trois patients ont ete inclus (57 hommes–36 femmes), d’âge moyen 51 ± 13 ans. Cinquante-neuf patients avaient une sclerose en plaques, 23 etaient blesses medullaires. Selon la methode utilisee, (Cl24 h, MDRDs, CKD-EPI creatinine) respectivement 54, 49 et 39 patients avaient une fonction renale alteree ; onze patients avaient des anomalies a l’echographie. La sensibilite de l’echographie comme indicateur indirect de la fonction renale etait selon la methode utilisee (Cl24 h, MDRDs, CKD-EPI creatinine) respectivement de 14 %, 8 % et 10 %. Conclusion L’echographie renale, examen indispensable dans le suivi des vessies neurologiques, n’est pas assez sensible pour depister une alteration de la fonction renale et doit continuer a etre associe a un examen mesurant la fonction renale et adapte aux patients neurologiques. Niveau de preuve 4.

Stopping an action in response to an unexpected event requires both that the event is attended to, and that the action is inhibited. Previous neuroimaging investigations of stopping have failed to adequately separate these cognitive elements. Here we used a version of the widely used Stop Signal Task that controls for the attentional capture of stop signals. This allowed us to fractionate the contributions of frontal regions, including the right inferior frontal gyrus and medial frontal cortex, to attentional capture, response inhibition, and error processing. A ventral attentional system, including the right inferior frontal gyrus, has been shown to respond to unexpected stimuli. In line with this evidence, we reasoned that lateral frontal regions support attentional capture, whereas medial frontal regions, including the presupplementary motor area (pre-SMA), actually inhibit the ongoing action. We tested this hypothesis by contrasting the brain networks associated with the presentation of unexpected stimuli against those associated with outright stopping. Functional MRI images were obtained in 26 healthy volunteers. Successful stopping was associated with activation of the right inferior frontal gyrus, as well as the pre-SMA. However, only activation of the pre-SMA differentiated stopping from a high-level baseline that controlled for attentional capture. As expected, unsuccessful attempts at stopping activated the anterior cingulate cortex. In keeping with work in nonhuman primates these findings demonstrate that successful motor inhibition is specifically associated with pre-SMA activation.

Resume But Le but de cette etude etait d’evaluer la sexualite des hommes atteints d’une maladie de Parkinson idiopathique. Patients et methodes Une etude descriptive visant a evaluer la sexualite des hommes ayant une maladie de Parkinson a ete realisee. Un autoquestionnaire valide (index international de la fonction erectile 15 questions) a ete adresse par courrier postal a 35 hommes d’âge moyen 68,1 ± 9 ans. Resultats Le taux de reponse etait de 42,9 % (15 patients). Les patients repondeurs etaient âges en moyenne de 68,7 ± 10,0 ans, atteints d’une maladie de Parkinson evoluant en moyenne depuis 10,4 ± 6,8 ans. Les troubles de la sexualite constituaient la deuxieme cause de consultation en urologie. Malgre un desir sexuel conserve, les patients avaient une alteration de leur sexualite, avec une diminution des scores de fonction erectile, de fonction orgasmique, de satisfaction des rapports et de satisfaction globale. Selon la classification de Cappelleri, la dysfonction erectile etait severe dans 54 % des cas et moderee dans 26,6 %. L’âge, l’institutionnalisation et les symptomes d’hyperactivite vesicale favorisaient l’alteration de la fonction erectile, de la fonction orgasmique et de la satisfaction des rapports pour le premier, le desir pour la deuxieme et la satisfaction globale et des rapports pour les derniers. Conclusion La fonction sexuelle des patients atteints de maladie de Parkinson idiopathique etait tres alteree. Le desir etait conserve mais l’ensemble des autres domaines de la sexualite masculine etait affecte.

Introduction/Background The Neuro-urology is a medical speciality, practiced by numerous urologists and doctors in physical medicine and rehabilitation (PMR), and corresponds to a need in terms of medical formation. In our hospital, during their studies, the interns in the Urology and PMR departments participate in weekly Neuro-Urology Multidisciplinary Team Meetings (MTM). This meeting could be a teaching place of this speciality. Our objective was to restructure MTM so that interns acquire skills to take in charge neurological urinary disorders, and also to evaluate the interest of the MTM as a teaching tool. Material and method Inter-alia, to restructure MTM, we taught a specific lesson at the beginning of the semester, distributed a booklet on neuro-urology and the meetings were more livened up. The assessment consisted of an anonymous evaluation by the interns of their perception of their knowledge, results expressed in median, and an assessment by the teacher of their knowledge from 2 clinical cases, results expressed in number of objectives acquired. It concerned 2 groups of interns: those before the intention of transforming the MTM (G1), with an evaluation only at the end of the semester (E1); and those who benefited on the restuctured MTM (G2), with evaluations at the beginning and the end of the semester (E2 and E3). Results The G1 interns perceived themselves at ease (median at 4.5) but their knowledge was not so good (6 objectives acquired/17). The G2 interns progressed, they significantly improved their own evaluation (median which went from 2 to 5/7, P = 0.018) and their knowledge, the number of objectives acquired passing from 6 to 14/17. Conclusion This work has shown the feasibility of transforming MTM as a teaching tool in the field of neuro-urology for interns.

Introduction/Background Motor imagery (MI) has emerged as a promising technique for promoting neuroplasticity and recovery of motor function after a stroke. It is used as an alternative to movement execution (ME). The brain structures involved in MI are largely documented but the existent functional connectivity (FC) during MI and the differences with ME in stroke patients remain underinvestigated. Functional magnetic resonance imaging (fMRI) techniques have the potential to reveal these changes. We aimed to investigate the FC during MI and ME and correlate FC measures between sensorimotor (SMN) regions with motor function of stroke patients. Material and method Twenty-four stroke patients with hemiparesis (time post-stroke = 10 ± 21 months; Upper-limb Fugl-Meyer Score (FMS) = 27.2 ± 13.5/66) were included. The patients underwent fMRI examination while they either imagined or executed wrist extension with their affected hand (AH). We studied FC using seed-to-voxels analysis. We compared the FC of SMN regions between MI and ME of AH movement. Additionally, correlations among brain FC measures and behavioral scores of motor function (FMS) were computed. Results During MI of the AH in comparison with ME, FC of the ipsilesional SMN (BA 40) was decreased with the ipsilesional somatosensory cortex (BA 2, 40, 5) and the cerebellum. In parallel, it was increased with the bilateral frontal cortex (BA 8, 10) ( Fig. 1 ). Besides this, correlation analyses with the FMS revealed that during MI, more impaired patients relied more on functional connections between contralasional BA4 and cerebellum (crus 1 and 2) than less impaired patients did. Conclusion The connectivity changes observed may reveal compensatory networks for MI implicating more the frontal lobe and the contralesional hemisphere in most impaired patients. These results characterized the connectivity patterns of ME and MI and may provide new insights into the neural mechanism underlying them.

Introduction/Background Neuropathic pain is frequent and often drug resistant, with an important impact on quality of life and function recovery. The aim of this study was to assess the efficacy of high frequency rTMS on motor cortex associated with motor imagery in patients with neuropathic pain. Material and method Between December 2014 and April 2017, 47 patients with central neuropathic pain were included. We studied clinical parameters (age, gender, pathology, pain duration and pain location) as well as cortical excitability. Before the treatment, a DN4 score and a BPI score were realized. Those two scores were repeated 48 hours after the treatment, at the beginning and at the end of 5 days of treatment, and during the follow up (at M1, M3 and M6). The treatment consisted in daily rTMS session, during five days, associated with motor imagery and mirror therapy. The primary outcome was a decreasing of the most intense pain of two points, defining responders. Results Thirty-four men and 13 women, 56,5 years old mean, with neuropathic pain from 6.6 years on average, principally secondary to stroke (n = 24) were included. Thirty percent of patients were responders at 48 hours, M1 and M3, and this diminution of pain was significant (all P Conclusion This study shows that high frequency TMS on the motor cortex associated with motor imagery can decrease neuropathic pain, as it is describes in literature, but durably with an effect until 3 months in our study. Furthermore, it may exist a link between responders at 48 hours and responders in the long term.

Introduction/Background Paired associative stimulation (PAS) is a non-invasive brain stimulation method that modulate cortical plasticity. Motor imagery (MI) can be used as an alternative to movement execution (ME) after stroke. In this study, we want to compare the motor and electrophysiological effects of a session combining PAS and MI exercises to sessions where only one of the intervention was delivered. Material and method MIPAS is a prospective, randomized, cross-over study. Twenty-three stroke patients with hemiparesis (mean age = 52 ± 13 years; time post-stroke = 10 ± 22 months; Upper-limb Fugl-Meyer Score (FMS) = 28 ± 13/66; Kinesthetic and Visual Imagery score (KVIQ_S) = 119 ± 23/140) were included and randomely assigned to one of the three 15 minutes session: PAS + MI; PAS; placebo PAS + MI. The PAS intervention consists of a combination of electrical stimulation of the hemiplegic Extensor Carpi Radialis (ECR) with cortical magnetic stimulation of the ECR cortical representation. In MI condition, the patient is instructed to imagine extension of his hemiplegic wrist and in Placebo PAS intervention, we used a sham probe. We compared the surface variation of the Motor Evoked Potential (MEP) of the ECR and the amplitude of Active Extension (AE) of the hemiplegic side after each session. Results In comparison with the other two sessions, significant facilitation associated with motor improvement was observed 15′ after the end of session placebo PAS + MI (ΔPEM(C) = +62% ± 96.7%; ΔEA(C) = +2.9 ± 6.7°). Significant motor improvement were observed after the sessions PAS + MI and PAS (ΔEA(A) = 4.1 ± 8.1°; ΔEA(B) = 5.4 ± 6.1°) but not association with cortical excitability changes. The motor improvement after the session PAS was significantly higher in comparison with that observed after session placebo PAS + MI. Conclusion Only the session Placebo PAS + MI seems to induce increased cortical excitability associated with motor improvement, the other sessions inducing only motor effect.

Introduction/Background Paired associative stimulation (PAS) is a specific non-invasive brain stimulations technique that allows to modulate motor plasticity in both patients and healthy participants. Our goal was to demonstrate a therapeutic interest for PAS with a lasting increase in motor cortex plasticity for extensor wrist (ECR) muscles and an improvement in upper limb function after 5 days of daily stimulation, in subacute post-stroke patients. Material and method A total of 24 patients were included in a double-blind, placebo-controlled trial and randomly assigned to one of two groups (PAS or sham). In the PAS condition, patients underwent a 5-day course of electrical peripheral stimulation, combined with magnetic cortical stimulation, which was applied to the ECR muscle in a single daily session at a frequency of 0.1 Hz for 30 min. It was associated with 2 hours of conventional physiotherapy. Variations in the motor evoked potential (MEP) surface area of the ECR muscle and Upper-Extremity Fugl-Meyer Motor Scale scores were analyzed up to Day 12. Results No significant difference was observed between the two groups on either electrophysiological or motor parameters. However, repetitive PAS sessions did seem to have an influence on patients with low initial cortical excitability. Conclusion The negative results underlines some methodological considerations: the inappropriate characteristic of post-stroke MEP for assessing motor recovery, the considerable variability in PAS effects between patients and across the sessions, the heterogeneity of post-stroke population. Five days of daily PAS session failed to improve motor functions in post-stroke patients: PAS cannot be recommended as therapeutic adjuvant in post-stroke rehabilitation.

Introduction/Background Ejaculation disorders are common in Spinal Cord Injury (SCI) patients and require often samples to preserve their fertility potential. The means to obtain ejaculation depend on the neurological level and the experience of the team. We reviewed the results of our cohort, the means used, particularly the benefits of adding Midodrine or penile vibratory stimulation (PVS) to obtain the sample. Material and method We collected retrospectively in our cohort of patients the epidemiological data, the type of ejaculation (anterograde or retrograde) and the means used to obtain a frozen sample of sperm. We compared the data of two groups: those who obtained an anterograde ejaculation (AE) and those only a retrograde (ER). Results Between January 2013 and July 2017, 86 patients were seen in consultation, with a mean age of 30 years, mainly after traumatic injury (90%), cervico-thoracic level (89%) and complete lesion (59%). Ejaculation was not obtained in 13 patients (15%): 7 (8%) were considered to be failing, 4 had dropped out of care, and 2 were starting treatment. AE and RE were obtained in 73 patients (85%), which could be frozen in 63 patients (73%) mainly from an EA for 47 patients. Only 9 patients were able to obtain their sperm by self-stimulation, the other 54 needed to use single or double PVS associated or not with Midodrine. In the only ER group, predominantly patients with complete deficiency below T10, the dose of Midodrine, the number of trials and the frequency of use of double PVS were more important than in the EA group (respectively 23.5 mg vs 9 mg, 3 vs 1.8, 64 vs 29%). Conclusion In SCI patients for whom it is difficult to obtain an ejaculation, it's fundamental to look for ER, repeat the tests, aided by increasing dose Midodrine and PVS.

Objectifs Le but de cette etude etait d’evaluer l’impact de la realisation d’une derivation urinaire non continente transileale de type Bricker sur la qualite de vie (QdV) des patients ayant des troubles vesicosphincteriens (TVS) d’origine neurologique.

Les troubles vesicosphincteriens dans la sclerose en plaques (SEP) sont frequents. La symptomatologie urinaire est polymorphe et le traitement le plus souvent medicamenteux. Le catheterisme intermittent (CI), traitement de reference chez le blesse medullaire, fait partie de l’arsenal therapeutique. Le but de cette etude etait d’evaluer prospectivement en intention de traiter l’observance, la satisfaction et l’impact sur la qualite de vie du CI chez les patients atteints d’une SEP. Nous avons suivi, entre 2004 et 2006, 170 patients atteints d’une SEP pour des troubles vesicosphincteriens. Les parametres etudies etaient l’incidence du CI, les caracteristiques des patients relevant du CI, la compliance et l’acceptation des patients au CI, le taux d’arret a moyen terme et l’impact du CI sur la qualite de vie des patients. L’indication de changement de mode mictionnel au profit du CI a ete retenue chez 55 patients (32 %). Cinq patients (9,1 %) ont refuse d’apprendre le CI, cinq patients (9,1 %) l’ont arrete au bout de 7 ± 4 mois. Pour un suivi moyen de 2,7 ± 4,7 ans, 45 patients pratiquent toujours le CI. Tous les patients qui pratiquaient le CI depuis au moins quatre mois etaient satisfaits, considerant que le CI ameliorait leur qualite de vie (Echelle numerique = 8/10). Le CI, chez les patients atteints d’une SEP, est bien accepte et ameliore la qualite de vie.

Resume Objectifs Evaluer la charge en soins des patients neurologiques operes dans un service d’urologie et la comparer a celle des patients oncologiques. Methode Entre 2006 et 2007, une etude prospective a ete realisee chez 15 patients consecutifs ayant des troubles vesicosphincteriens d’origine neurologique pris en charge par la realisation d’une cystectomie laparoscopique associee a une derivation non continente de type Bricker. La charge en soins a ete evaluee par la methode de soins infirmiers individualises a la personne soignee (SIIPS). Trois types de soins ont ainsi ete evalues : les soins de base (SB), techniques (ST) et relationnels (SR). Les resultats ont ete compares aux 15 premiers patients operes durant la meme periode d’une cystectomie laparoscopique associee a une derivation non continente de type Bricker pour un cancer de vessie. Resultats La charge en soins de base etait superieure chez les patients neurologiques par rapport aux patients oncologiques la veille de l’intervention et a compter du troisieme jour postoperatoire jusqu’au huitieme jour postoperatoire. La charge en soins relationnels etait superieure chez les patients neurologiques par rapport aux patients oncologiques les deuxieme, troisieme, sixieme et septieme jours postoperatoires. Aucune difference n’a ete notee en termes de soins techniques entre les deux groupes. Conclusion En dehors du jour de l’intervention et du premier jour postoperatoire, la charge en soins de base et relationnels est plus elevee chez les patients neurologiques que chez les patients oncologiques. Aucune difference n’a ete notee en termes de soins techniques entre les deux groupes.

Objectif Evaluer l’evolution de la fonction renale, apres derivation urinaire transileale selon Bricker, chez les patients presentant des troubles vesicosphincteriens d’origine neurologique.

Objectif. - Evaluer l'efficacite clinique et urodynamique et la duree d'efficacite des injections intradetrusoriennes de toxine botulique A (TBA) chez des patients ayant une hyperactivite detrusorienne d'origine neurologique refractaire aux traitements anticholinergiques. Patients et methodes. - Entre 2004 et 2005, 33 patients (19 hommes et 14 femmes), ayant une hyperactivite detrusorienne neurogene ont ete traites par des injections intradetrusoriennes de 300 U de TBA (Botox®) en 30 points. Tous les patients etaient en echec, intolerants ou avaient des contre-indications, aux traitements anticholinergiques. Tous les patients urinaient par autosondages. Resultats. ¯ A six semaines des injections de TBA, le taux de succes etait de 75,8%, d'amelioration de 12,1% % et d'echec de 9,1 %. Le nombre moyen d'autosondages sur 24heures etait significativement diminue (6,37 versus 5,2, p=0,02), le volume mictionnel maximal augmente (321,68ml versus 536,25ml, p=0,002), le nombre moyen de fuites par 24heures diminue (7,39 versus 0,03, p

Functional imaging has provided new evidence of the neurobiological impact of the treatment of aphasia, including speech therapy, through the alteration of the activated language neural network. In such a way, speech therapy has proved its impact. The role of each hemisphere is still very unclear. Some of the authors link the left-lateralisation of activations to the therapeutic improvement of language and the right-activated network to a maladaptative strategy, whereas others consider the latter as a useful compensatory network for speech disorders. Repetitive trans-cranial magnetic stimulation (rTMS), first used to determine cortical activity, is now used to directly interfere with cerebral activity. In the years to come, rTMS should be developed as an adjuvant therapy for aphasia.

Background. The effects of physiotherapy are difficult to assess in very impaired early stroke patients. Objective. The aim of the study was to characterize the impact of 4 weeks of passive proprioceptive training of the wrist on brain sensorimotor activation after stroke. Methods. Patients with a subcortical ischemic lesion of the pyramidal tract were randomly assigned to a control or a wrist-training group. All patients had a single pure motor hemiplegia with severe motor deficit. The control group (6 patients) underwent standard Bobath rehabilitation. The second, “trained,” group (7 patients) received Bobath rehabilitation plus 4 weeks of proprioceptive training with daily passive calibrated wrist extension. Before and after the training period, patients were examined with validated clinical scales and functional MRI (fMRI) while executing a passive movement versus rest. The effect of standard rehabilitation on sensorimotor activation was assessed in the control group on the wrist, and the effect of standard rehabilitation plus proprioceptive training was assessed in the trained group. The effect of 4-week proprioceptive training alone was statistically evaluated by difference between groups. Results. Standard rehabilitation along with natural recovery mainly led to increases in ipsilesional activation and decreases in contralesional activation. On the contrary, standard rehabilitation and paretic wrist proprioceptive training increased contralesional activation. Proprioceptive training produced change in the supplementary motor area (SMA), prefrontal cortex, and a contralesional network including inferior parietal cortex (lower part of BA 40), secondary sensory cortex, and ventral premotor cortex (PMv). Conclusion. We have demonstrated that purely passive proprioceptive training applied for 4 weeks is able to modify brain sensorimotor activity after a stroke. This training revealed fMRI change in the ventral premotor and parietal cortices of the contralesional hemisphere, which are secondary sensorimotor areas. Recent studies have demonstrated the crucial role of these areas in severely impaired patients. We propose that increased contralesional activity in secondary sensorimotor areas likely facilitates control of recovered motor function by simple proprioceptive integration in those patients with poor recovery.

The first objective of the study was to determine whether functional magnetic resonance imaging (fMRI) signal was correlated with motor performance at different stages of poststroke recovery. The second objective was to assess the existence of prognostic factors for recovery in early functional MR images. Eight right-handed patients with pure motor deficit secondary to a first lacunar infarct localized on the pyramidal tract were included. This study concerned moderately impaired patients and recovery of handgrip strength and finger-tapping speed. The fMRI task was a calibrated flexion--extension movement. Ten healthy subjects served as a control group. The intensity of the activation in the ‘‘classical’’ motor network (ipsilesional S1M1, ipsilesional ventral premotor cortex [BA 6], contralesional cerebellum) 20 days after stroke was indicative of the performance (positive correlation). The cluster in M1 was posterior and circumscribed to BA 4p. No area was associated with bad performance (negative correlation). No correlation was found 4 and 12 months after stroke. Prognosis factors were evidenced. The higher early the activation in the ipsilesional M1 (BA 4p), S1, and insula, the better the recovery 1 year after stroke. Although the lesions partly deefferented the primary motor cortex, patients who activated the posterior primary motor cortex early had a better recovery of hand function. This suggests that there is benefit in increasing ipsilesional M1 activity shortly after stroke as a rehabilitative approach in mildly impaired patients.

The assessment of renal function is essential to follow up the patients with neurogenic bladder. The objective of this study was to determine if renal ultrasonography would both evaluate the morphology of the urinary tract and renal function.In a retrospective study, all patients followed for neurogenic bladder were included, regardless of their neurological disease. Renal function was estimated by creatinine clearance (Cl24 h), the reference test in neurological patients, the glomerular filtration rate by the MDRD simplified (MDRDs) and CKD-EPI creatinine formula, and we identified renal abnormalities detected on ultrasonography.One hundred and three patients were included (57 men-36 women), mean age 51±13 years. Fifty-nine patients had multiple sclerosis, 23 spinal cord injury. Depending on the method used (Cl24h, MDRDs, CKD-EPI creatinine) respectively 54, 49 and 39 patients had abnormal renal function; eleven patients had abnormal findings on renal ultrasonography. The sensitivity of ultrasonography as an indirect indicator of renal function depending on the method used (Cl24h, MDRDs, CKD-EPI creatinine) was equal respectively to 14%, 8% and 10%.Renal ultrasonography, which is essential to follow up the neurogenic bladder, is not enough sensitive to detect abnormal renal function and should continue to be associated with an evaluation of renal function, which is suitable for neurological patients.4.

Objectives The aim of this study is to develop a valid and standardized instrumental analysis of upper limb (UL) motion in stroke patients. Methods Sixteen controls and 15 hemiparetic subjects (mean age = 54 ± 18,2 years old; Fugl-Meyer Upper Limb 41,4 ± 12,4) underwent kinematic motion analysis (passive markers, Optitrack) of pointing and grasping tasks. We examined the ability to perform a single pointing task and three reach-to-grasp tasks: key turning, reaching and grasping a can, reaching and grasping a cube; at a self-selected speed and as fast as possible. Speed, accuracy and efficiency of each movement were quantified and compared between controls and hemiparetic subjects, and between the ipsilateral of control subjects and the affected side; to describe reaching and grasping. Results For reaching, movement time of hemiparetic UL was longer, less smooth (peak velocity, jerk), less direct (higher index path ratio) and associated with more trunk compensation (higher trunk/hand ratio). Movement time, jerks and trunk/hand ratio were the most discriminant variables between hemiparetic UL and ipsilateral/control UL, in any task analysed. Trunk displacement was greater in grasping than in reaching tasks. For grapsing tasks, movement time is the most discriminant factor between hemiparetic and control/ipsilateral UL, especially for the key turn task. Movement alterations were also found for ipsilateral limb. Association between kinematic variables and clinical features during reaching time (Fugl-Meyer, MAL, WFMT, ARAT) was greater for the task “grasping a can”. Discussion/conclusion Our results are similar to those of the literature, but suggest that we have to privilege some of the most relevant kinematic parameters. This standardization phase emerging after a validation phase of the techniques can make the biomechanical analysis of the upper limb as easy and valid as gait analysis and should help to develop the quantified measurement of prehension. This protocol is currently in process to objectively assess the therapeutic effects of rehabilitation treatments (botulinum toxin, induced constraint therapy).

Introduction Post-stroke aphasia makes it difficult to assess cognitive deficiencies. We thus developed the CASP, which can be administered without using language. Our objective was to compare the feasibility of the CASP, the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) in aphasic stroke patients. Material and methods All aphasic patients consecutively admitted to seven French rehabilitation units during a 4-month period after a recent first left hemispheric stroke were assessed with CASP, MMSE and MoCA. We determined the proportion of patients in whom it was impossible to administer at least one item from these 3 scales, and compared their administration times. Results Forty-four patients were included (age 64 ± 15, 26 males). The CASP was impossible to administer in eight of them (18%), compared with 16 for the MMSE (36%, P = 0.05) and 13 for the MoCA (30%, P = 0.21, NS). It was possible to administer the CASP in all of the patients with expressive aphasia, whereas the MMSE and the MoCA could not be administered. Administration times were longer for the CASP (13 ± 4 min) than for the MMSE (8 ± 3 min, P Conclusion The CASP is more feasible than the MMSE and the MoCA in aphasic stroke patients.

Objectives Transcranial magnetic stimulations (TMS) have been used for many years as a diagnostic tool to explore changes in cortical excitability, and more recently as a tool for therapeutic neuromodulation. We are interested in their applications following brain injury: stroke, traumatic and anoxic brain injury. Data synthesis Following brain injury, there is decreased cortical excitability and changes in interhemispheric interactions depending on the type, the severity, and the time-lapse between the injury and the treatment implemented. rTMS (repetitive TMS) is a therapeutic neuromodulation tool which restores the interhemispheric interactions following stroke by inhibiting the healthy cortex with frequencies ≤ 1 Hz, or by exciting the lesioned cortex with frequencies between 3 and 50 Hz. Results in motor recovery are promising and those in improving aphasia or visuospatial neglect are also encouraging. Finally, the use of TMS is mainly limited by the risk of seizure, and is therefore contraindicated for many patients. Conclusion TMS is a useful non-invasive brain stimulation tool to diagnose the effects of brain injury, to study the mechanisms of recovery and a non-invasive neuromodulation promising tool to influence the post-lesional recovery.

International audience; Stroke rehabilitation has undergone a revolution over the last three decades. Cohort studies have consistently reinforced the importance of poststroke rehabilitation to stimulate recovery, but the concepts of empirical methods originally proposed by therapists to rehabilitate these patients have not withstood clinical analysis. Functional neuroimaging and animal models have unveiled the mechanisms underlying functional recovery and helped teams understand its limitations and improvement modalities. These neuroscience discoveries constitute the grounds needed to understand the emergence of new technologies: robotics and virtual reality. The objective of this review of the literature was to select key works in this field to better understand current therapeutic possibilities.

Surgical treatment of perineal pressure sores could be done with various fascio-cutaneous or musculo-cutaneous flaps, which provide cover and filling of most of pressure sores after spinal cord injuries. In rare cases, classical solutions are overtaken, then it is necessary to use more complex techniques. We report a case of a made-to-measure lower limb flap for coverage of confluent perineal pressure sores.A 49-year-old paraplegic patient developed multiple pressure sores on left and right ischial tuberosity, inferior pubic bone and bilateral trochanters with hips dislocation. Surgical treatment involved a whole right thigh flap to cover and fill right side lesions, associated to a posterior right leg musculo-cutaneous island flap to cover and fill the left trochanteric pressure sore.The surgical procedure lasted 6.5 hours and required massive blood transfusion. Antibiotics were adapted to bacteriological samples. There were no postoperative complications; complete wound healing occurred after three weeks.A lower limb sacrifice for coverage of a giant perineal pressure sores is an extreme surgical solution, reserved to patients understanding the issues of this last chance procedure. A good knowledge of vascular anatomy is an essential prerequisite, and allows to shape made-to-measure flaps. The success of such a procedure is closely linked to the collaboration with the rehabilitation team (appropriate therapeutic education concerning transfers and positioning).

International audience; Purpose Lower urinary tract dysfunction is common in multiple sclerosis (MS). The purpose of this study was to prospectively evaluate the impact of intermittent catheterization (IC) on the quality of life of patients affected by MS. Methods Between 2007 and 2009, we admitted 23 patients to teach them the technique of IC. Their quality of life was evaluated before and more than 6 months after the beginning of learning the technique, when the urinary situation was stable. Two questionnaires were used: one specific for urinary disorders (QUALIVEEN Ò) and one general (SF-36 Ò). Results Twenty-two patients followed this different way of bladder emptying. More than 6 months (9.3 ± 3 months on average) after first learning to use IC, the impact of urinary disorders explored by Qualiveen Ò had significantly decreased (the overall quality of life; bother with limitation; fears; feelings; Wilcoxon's test, respectively p = 0.004; 0.007; 0.02; 0.02) while the quality of life was not diminished. Conclusion Intermittent catheterization (IC) in association with overall urinary management, among patients affected by MS, is well accepted and reduces the impact of urinary dysfunction on their quality of life.

Les troubles vesico-sphincteriens (TVS) sont frequents au cours des pathologies neurologiques. Le TENS est une alternative therapeutique interessante dans la prise en charge des symptomes urinaires et pelvi perineaux. L'objectif de ce travail est d'evaluer l'efficacite du TENS, en pratique courante, chez les patients suivis dans les services du CHU Toulouse Rangueil pour des TVS d'origine neurologique, sans discrimination sur la nature des troubles ni la pathologie neurologique sous-jacente. Nous avons realise une etude retrospective sur des patients chez qui le TENS a ete prescrit a visee urinaire entre 2008 et 2013. Sur les 67 patients etudies, on retrouve que plus de 70% rapportaient une efficacite de la stimulation. Nous avons realise une etude prospective entre juin 2014 et septembre 2015 ou 33 patients ont ete inclus. 23 patients ont ete suivis a 2 mois (M2) et 15 patients a 6 mois (M6) du debut de la stimulation. Le TENS a ete prescrit a l'achat apres 2 mois d'essai pour 63.3% des patients. On retrouve une diminution statistiquement significative des symptomes d'HAV (hyperactivite vesicale) (p=0.012) et de dysurie (p=0.0322) evalues par le score USP a M2. On retrouve une diminution statistiquement significative de la gene liee aux troubles urinaires evaluee par le Qualiveen a M2 (p=0.03). On ne met pas en evidence de difference significative a M6. L'etude des correlations montre que le TENS ameliore les patients tres symptomatiques (sur l'HAV a M2 et M6) ou tres invalides en termes de qualite de vie (sur le Qualiveen total a M2 et sur le vecu a M2 et M6). L'amelioration de l'HAV et de la dysurie a M2 est associee statistiquement a la prescription du TENS a l'achat. Aucun effet secondaire n'a ete rapporte. Le TENS peut donc etre considere comme un bon traitement symptomatique des troubles vesico-sphincteriens d'origine neurologique, a condition qu'il ne s'oppose pas au traitement de reference pour les populations a risque.

Lesion parietale Contexte.– L’heminegligence est un syndrome caracterise par des perturbations de l’exploration spatiale de l’hemichamp gauche avec un comportement devie vers la droite. De part la diversite de ses manifestations et des atteintes cerebrales pouvant en etre a l’origine, l’heminegligence pose probleme, aussi bien sur le plan physiopathologique, diagnostique que therapeutique. Nous avons transpose sur interface informatique le test de barrage des cloches (Gauthier 1989). Objectif .– Etablir les effets de la saillance, globale ou predominante a gauche, par la couleur et/ou par le mouvement sur l’exploration visuelle selon chaque hemichamp. Trois groupes de patients cerebroleses sont evalues : 24 patients diagnostiques heminegligents, 12 patients ayant recupere totalement de leur heminegligence et 12 patients n’ayant jamais presente d’heminegligence. Resultats.– L’informatisation du test pouvait etre consideree comme valide puisqu’il existait une difference significative entre les trois groupes pour le nombre de cibles touchees, la colonne de la premiere cible et la vitesse d’execution (p < 0,001 pour les trois). Notre etude a permis de mettre en evidence que la vitesse d’execution des patients heminegligents est amelioree par l’introduction d’une saillance globale par la couleur (1,8 secondes entre deux cibles versus 3,8 secondes entre deux cibles ; p < 0,001) ou le mouvement (3,2 secondes versus 3,9 ; p < 0,001). De plus, l’introduction d’une saillance lateralisee a gauche permet d’ameliorer la vitesse d’execution dans cet hemichamp et, donc, de surpasser le biais spatial droit. Ainsi, l’effet pop-out persiste chez les heminegligents dans l’hemichamp droit comme gauche. Puisque la saillance lateralisee permet aux heminegligents de surpasser leur biais spatial, nous suggerons que des exercices de reeducation via ce support informatique, pourraient aider les patients a gerer leur trouble de l’exploration spatiale.

Errors trigger changes in behavior that help individuals adapt to new situations. The dorsal anterior cingulate cortex (dACC) is thought to be central to this response, but more lateral frontal regions are also activated by errors and may make distinct contributions. We investigated error processing by studying 2 distinct error types: commission and timing. Thirty-five subjects performed a version of the Simon Task designed to produce large number of errors. Commission errors were internally recognized and were not accompanied by explicit feedback. In contrast, timing errors were difficult to monitor internally and were explicitly signaled. Both types of error triggered changes in behavior consistent with increased cognitive control. As expected, robust activation within the dACC and bilateral anterior insulae (the Salience Network) was seen for commission errors. In contrast, timing errors were not associated with activation of this network but did activate a bilateral network that included the right ventral attentional system. Common activation for both error types occurred within the pars operculari and angular gyri. These results show that the dACC does not respond to all behaviorally salient errors. Instead, the error-processing system is multifaceted, and control can be triggered independently of the dACC when feedback is unexpected.

Traumatic brain injury (TBI) frequently produces impairments of attention in humans. These can result in a failure to maintain consistent goal-directed behavior. A predominantly right-lateralized frontoparietal network is often engaged during attentionally demanding tasks. However, lapses of attention have also been associated with increases in activation within the default mode network (DMN). Here, we study TBI patients with sustained attention impairment, defined on the basis of the consistency of their behavioral performance over time. We show that sustained attention impairments in patients are associated with an increase in DMN activation, particularly within the precuneus and posterior cingulate cortex. Furthermore, the interaction of the precuneus with the rest of the DMN at the start of the task, i.e., its functional connectivity, predicts which patients go on to show impairments of attention. Importantly, this predictive information is present before any behavioral evidence of sustained attention impairment, and the relationship is also found in a subgroup of patients without focal brain damage. TBI often results in diffuse axonal injury, which produces cognitive impairment by disconnecting nodes in distributed brain networks. Using diffusion tensor imaging, we demonstrate that structural disconnection within the DMN also correlates with the level of sustained attention. These results show that abnormalities in DMN function are a sensitive marker of impairments of attention and suggest that changes in connectivity within the DMN are central to the development of attentional impairment after TBI.

to assess the sexual function in men with idiopathic Parkinson's disease.a cross-sectional study was performed in 35 men, mean age 68 ± 9 years, with idiopathic Parkinson's disease followed in a single urological department. The 15 questions International Index of the Erectile Function was sent by postal mail.the answer's rate was 42.9% (15 patients). The mean age of the responders was 68.7 ± 10.0 years. Mean duration of the disease was 10.4 ± 6.8 years. Sexual dysfunction was the second cause for consultation in urology. Despite a sustained sexual desire, patients had an altered sexual function with low erectile function, orgasmic function, intercourse satisfaction and total satisfaction scores. According to the Cappelleri's classification, the erectile dysfunction was severe in 54% of the cases and moderate in 26.6%. Age, institutionalization and overactive bladder symptoms were associated with erectile, orgasmic function and intercourse satisfaction alteration, sexual desire alteration, intercourse and global satisfaction alteration, respectively.men with idiopathic Parkinson's disease had a severe sexual dysfunction. The sexual desire was usually maintained but all the other domains were severely altered.

International audience; Functional imaging has provided new evidence of the neurobiological impact of the treatment of aphasia, including speech therapy, through the alteration of the activated language neural network. In such a way, speech therapy has proved its impact. The role of each hemisphere is still very unclear. Some of the authors link the left-lateralisation of activations to the therapeutic improvement of language and the right-activated network to a maladaptative strategy, whereas others consider the latter as a useful compensatory network for speech disorders. Repetitive trans-cranial magnetic stimulation (rTMS), first used to determine cortical activity, is now used to directly interfere with cerebral activity. In the years to come, rTMS should be developed as an adjuvant therapy for aphasia.

To evaluate the clinical and urodynamic efficacy and duration of efficacy of intradetrusor botulinum toxin A (BTA) injections in patients with neurogenic overactive bladder refractory to anticholinergic therapy.Between 2004 and 2005, 33 patients (19 men and 14 women), with neurogenic overactive bladder were treated by intradetrusor injections of 300 U of BTA (Botox) in 30 points. All patients were refractory to, intolerant of or presented contraindications to anticholinergic therapy. All patients voided by intermittent self-catheterization.Six weeks after BTA injections, the success rate was 75.8%, with improvement in 12.1% of cases and failure in 9.1% of cases. The mean number of self-catheterizations per 24 h was significantly decreased (6.37 versus 5.2, P=0.02), the maximum voiding volume was increased (321.68 ml versus 536.25 ml, P=0.002), the mean number of episodes of incontinence per 24 h was decreased (7.39 versus 0.03, P0.0001), the proportion of patients with incontinence was decreased (66.66% versus 6.04%, P0.0001), the mean maximum cystomanometric capacity was increased (286.75 ml versus 554.16 ml, P=0.002) and the mean maximum intravesical pressure was decreased (54.8 cm H(2)O versus 5.3 cm H(2)O, P0.0001). After BTA injections, 87.8 % of patients no longer experienced uninhibited contractions. The median duration of clinical efficacy was 7.03 months. At 12 months, injections were still effective clinically in 21.2 % of patients.Intradetrusor BTA injections are an effective and well tolerated treatment for neurogenic overactive bladder. Their clinical efficacy persisted for more than 12 months in more than 20% of cases.

Objectives The Paired Associative Stimulation (PAS) is a non-invasive brain stimulation technique combining an electrical peripheral stimulation and a magnetic cortical stimulation. Applied on the wrist extensor muscles, one session induced changes in cortical excitability. We studied the effects of a repetition of 5 PAS sessions against placebo. Material and methods This is a prospective, randomized, double-blind against placebo study. One session consisted in applying an electrical peripheral stimulation on the wrist extensor muscle followed by a 25-ms later magnetic cortical stimulation over the wrist area, at a 0.1-Hz frequency during 30 minutes, the patient receiving 180 paired stimuli. In the SHAM group, the patient received the electrical peripheral stimulation and a SHAM magnetic stimulation. One session was applied every day during 5 days. The changes in area of the motor-evoked potential (MEP), reflecting the changes in cortical excitability, and motor changes studied by the Fugl-Meyer score were assessed at the end of the 1st and 5th session, 3, 5 and 7 days after the end of the 5 days session. Results Twenty-eight patients were included (19 men, mean age: 49.9 ± 13.5 years), with stroke from 10.0 ± 5.1 weeks. Only data from 24 patients were exploitable, 13 patients being included in the PAS group. It was not found significant differences between the two groups regardless of the time after stimulation, or the electrophysiological parameters, neither the motor scores. However, there is a greater MEP variability in the PAS group compared to the SHAM group. All patients ( n = 5) for which PAS increased cortical excitability (D8-MEP > +200% D1-MEP) were those with a low initial level of cortical excitability. Discussion The initial level of cortical excitability seems to play a key role of repeated sessions of PAS on the lasting effects on brain plasticity. Our results confirm the importance of the initial level of neuronal activation in the cortical modulation induced by TMS.

Objective Motor imagery (MI) is a cognitive process of imagining a movement without actually doing it. This technique has demonstrated its benefits in the rehabilitation of hemiplegic patients. Non-invasive brain stimulation (NIBS) is still at a preclinical stage but has demonstrated their adjunct effect in the learning of a motor task. In this study, we studied the motor and electrophysiological effects of a session combining Paired Associative Stimulation (PAS), a technique of NIBS and MI exercises (PAS-MI). Methods A prospective, randomized cross-over study where six patients were included (4 men, age = 44.5 ± 13.7 years; 5.7 ± 7.7 months post-stroke). They randomly underwent three 15-minute sessions of stimulation, one week apart: PAS-MI, PAS alone and ShamPAS associated with MI exercises (ShamPAS-MI). The PAS intervention consisted in an electrical stimulation of the hemiplegic extensor carpi radialis (ECR) associated with cortical magnetic stimulation over the wrist motor area. In MI condition, the patient was instructed to imagine extension of his hemiplegic wrist and in ShamPAS intervention, we used a SHAM probe. We compared the surface variation of the motor-evoked potential (MEP) of the ECR and the amplitude of active extension (AE) of the hemiplegic side obtained after each session. Results Twenty-five minutes after the end of session PAS alone, an increase of MEP surface (+91% ± 150.3%) which reveals a higher cortical excitability associated with a slight motor improvement (ΔEA = 1.33 ± 3.14°) was shown. A smaller facilitation was shown after sessions PAS-MI and ShamPAS-MI (+45.97 ± 134.32% and 44.85 ± 28.77%, respectively) and, in these cases, was not associated with motor improvement. Conclusion The session PAS alone seems to induce motor improvement associated with increased cortical excitability not shown after the other two sessions. The combination of two types of stimuli seems to have less effect, perhaps because of the mechanisms regulating the homeostasis of brain plasticity. The results have to be confirmed on a larger sample.