Isabelle Benatru

Association of Parkinson's Disease and Its Subtypes with Agricultural Pesticide Exposures in Men: A Case-Control Study in France.

Background Pesticides have been associated with Parkinson’s disease (PD), but there are few data on important exposure characteristics such as dose–effect relations. It is unknown whether associations depend on clinical PD subtypes. Objectives We examined quantitative aspects of occupational pesticide exposure associated with PD and investigated whether associations were similar across PD subtypes. Methods As part of a French population-based case–control study including men enrolled in the health insurance plan for farmers and agricultural workers, cases with clinically confirmed PD were identified through antiparkinsonian drug claims. Two controls were matched to each case. Using a comprehensive occupational questionnaire, we computed indicators for different dimensions of exposure (duration, cumulative exposure, intensity). We used conditional logistic regression to compute odds ratios (ORs) and 95% confidence intervals (CIs) among exposed male farmers (133 cases, 298 controls). We examined the relation between pesticides and PD subtypes (tremor dominant/non-tremor dominant) using polytomous logistic regression. Results There appeared to be a stronger association with intensity than duration of pesticide exposure based on separate models, as well as a synergistic interaction between duration and intensity (p-interaction = 0.04). High-intensity exposure to insecticides was positively associated with PD among those with low-intensity exposure to fungicides and vice versa, suggesting independent effects. Pesticide exposure in farms that specialized in vineyards was associated with PD (OR = 2.56; 95% CI: 1.31, 4.98). The association with intensity of pesticide use was stronger, although not significantly (p-heterogeneity = 0.60), for tremor-dominant (p-trend < 0.01) than for non-tremor–dominant PD (p-trend = 0.24). Conclusions This study helps to better characterize different aspects of pesticide exposure associated with PD, and shows a significant association of pesticides with tremor-dominant PD in men, the most typical PD presentation. Citation Moisan F, Spinosi J, Delabre L, Gourlet V, Mazurie JL, Bénatru I, Goldberg M, Weisskopf MG, Imbernon E, Tzourio C, Elbaz A. 2015. Association of Parkinson’s disease and its subtypes with agricultural pesticide exposures in men: a case–control study in France. Environ Health Perspect 123:1123–1129; http://dx.doi.org/10.1289/ehp.1307970

Clinical Spectrum of Movement Disorders after Stroke in Childhood and Adulthood

Although rare, many different types of hyperkinetic and hypokinetic movement disorders have been described after both ischemic and hemorrhagic stroke in children and in adults. Current knowledge about these disorders comes from single case reports or small series of cases compiled from retrospective studies. Data from hospital-based studies suggest a prevalence of poststroke movement disorders ranging from 1.1 to 3.9%. However, despite the development of emergency care for stroke, these clinical syndromes remain insufficiently recognized. Poststroke movement disorders take place in the acute phase or following a variable delay after stroke onset, and could be transient or persistent. Dystonia is the most frequent movement disorder, occurring after a delay of several months, while chorea and hemiballism are most frequent in the acute stages. Amongst transient movement disorders, limb shaking is associated with high-grade stenosis or occlusion of the internal carotid artery, while myoclonus and asterixis are rare. From a pathophysiological point of view, most of these symptoms are induced by a lesion involving the basal ganglia, the thalamus, or the frontal subcortical pathways. In this article, we updated the clinical spectrum, neuropathophysiological mechanisms, and prognosis of stroke-induced movement disorders in adults and children.

Les accidents vasculaires cérébraux : ce qui a changé au début du xxie siècle

INTRODUCTION Striking developments in stroke epidemiology, initially based on the results of the Framingham study, have greatly improved our neuroepidemiological knowledge of the disease. STATE OF ART The development of stroke registries has made it possible to evaluate the descriptive epidemiology of stroke and its evolution. With the increasing use of CT-scan, MRI, and either cardiac or vascular imaging, the diagnosis of stroke and its subtypes has been made easier. Over the last 20 years, a decrease in the incidence and mortality of stroke has been observed in Western countries. In contrast, in Dijon, which has the only population-based stroke registry in France, stable incidence rates have been reported. However, over the same period, age at stroke onset has risen by five years in men and eight years in women, which is probably related to both population aging and improvements in primary prevention and general health. The reported decrease in case-fatality rates suggests better acute management of stroke patients, and explains in part the increase in the prevalence of stroke. In addition, the assessment of vascular risk factors has demonstrated that high blood pressure remains the principal risk factor for both ischemic and hemorrhagic stroke, and that antihypertensive treatment is able to reduce stroke incidence. PERSPECTIVES Epidemiology studies could make it possible to measure the impact of new therapeutic strategies applied in both primary and secondary prevention. CONCLUSION Prevention, diagnosis, and acute treatment of stroke have considerably improved, but cerebrovascular diseases together with myocardial infarction remain the leading cause of death. Despite the absence of a rise in the incidence of stroke, its prevalence has increased. This is due to the decrease in case-fatality rates. As a consequence, there is an urgent need to organize health networks around stroke. Moreover, the rise in stroke-free life expectancy is a positive finding that reflects improvements in prevention.

Pollution de l’air et pathologie athérothrombotique cardiaque et cérébrale: Données épidémiologiques

Recent convergent data suggest that air pollution affects the risk of acute atherothrombotic events including both myocardial infarction and ischemic stroke. The principal epidemiologic studies begun in the 1990s first examined the respiratory effects of atmospheric pollution and then focused on how pollution peaks affected cardiovascular risk. These studies used data from large metropolitan areas in North America and Asia as well as several large European cities to demonstrate the clear existence of a relation between air pollution and cardio- and cerebrovascular mortality. They also observed an increase in hospital admissions for myocardial infarctions and cerebrovascular accidents on days with high air pollution levels. The pollutants involved have not yet been clearly designated, but it appears that fine suspended particulate matter (PM2.5) and gaseous pollutants such as ozone appear to contribute strongly to these harmful effects. A complete analysis of these data shows the need for a thorough evaluation of the cardio- and cerebrovascular risks associated with air pollution, especially in French metropolitan areas. Precise identification of those at high risk from specific pollutants is essential to improve targeting of prevention strategies.Points essentiels Des donnees recentes et convergentes de la litterature suggerent l’existence d’un effet de la pollution de l’air ambiant sur le risque d’evenements atherothrombotiques aigus d’origine cardiaque (infarctus du myocarde) ou cerebral (accident vasculaire cerebral). Les principales etudes epidemiologiques entreprises a partir des annees 1990 se sont d’abord interessees aux effets respiratoires de la pollution atmospherique, puis se sont ensuite focalisees sur les effets des pics de pollution sur le risque cardiovasculaire. A partir des donnees issues des grandes agglomerations du continent nord americain ou asiatique et de quelques grandes villes europeennes, ces etudes ont clairement demontre l’existence d’une relation entre les taux de pollution de l’air ambiant et la mortalite d’origine cardio ou cerebrovasculaire. Elles ont egalement constate une augmentation des admissions hospitalieres pour infarctus du myocarde ou pour accident vasculaire cerebral les jours de forte pollution de l’air. Les polluants responsables ne sont pas encore clairement designes mais il semblerait que les particules fines en suspension dans l’air, ou des polluants gazeux comme l’ozone, puissent contribuer fortement a ces effets deleteres. L’analyse de l’ensemble des donnees de la litterature montre la necessite d’une evaluation complete des risques cardio et cerebrovasculaires lies a la pollution de l’air ambiant, en particulier dans le contexte de nos agglomerations francaises. Une identification precise des personnes a haut risque vis-a-vis des polluants est indispensable afin de mieux orienter les strategies de prevention.

Dissémination leptoméningée après chirurgie d’un adénocarcinome de l’ethmoïde

INTRODUCTION Although rare, adenocarcinoma is the most frequent neoplasm of the ethmoid sinus and must be regarded as an occupational disease secondary to chronic wood dust exposure. Few cases with neurological metastasis have been reported. CASE REPORT We report the cases of two patients who developed a multiple cranial nerve disorder for the first case and a cauda equina syndrome for the second, after ethmoid adenocarcinoma surgery. CONCLUSION Diagnosis of carcinomatous meningitis is difficult and is based on clinical data, CSF analysis and gadolinium-enhanced T1-weighted brain and spinal cord MRI. The implication of surgery is discussed. Prognosis of such a disorder is poor.

Pollution de l'air et pathologie athérothrombotique cardiaque et cérébrale: Bases physiopathologiques et groupes à risque

Key points The pathophysiologic basis of the harmful action of air pollutants rests principally on their proinflammatory and prothrombotic effects. The principal pollutants currently identified as responsible for these effects are fine suspended particles (PM2.5) and ozone. Inflammatory effects, initially localized in the lungs, then become systemic. Analysis of groups at the highest risk of atherothrombotic events suggests the elderly may be most sensitive to the effects of air pollution.The pathophysiologic basis of the harmful action of air pollutants rests principally on their proinflammatory and prothrombotic effects. The principal pollutants currently identified as responsible for these effects are fine suspended particles (PM2.5) and ozone. Inflammatory effects, initially localized in the lungs, then become systemic. Analysis of groups at the highest risk of atherothrombotic events suggests the elderly may be most sensitive to the effects of air pollution.

NeuroépidémiologieLes accidents vasculaires cérébraux : ce qui a changé au début du xxie siècleWhat has changed for stroke at the beginning of the 21st century

INTRODUCTION Striking developments in stroke epidemiology, initially based on the results of the Framingham study, have greatly improved our neuroepidemiological knowledge of the disease. STATE OF ART The development of stroke registries has made it possible to evaluate the descriptive epidemiology of stroke and its evolution. With the increasing use of CT-scan, MRI, and either cardiac or vascular imaging, the diagnosis of stroke and its subtypes has been made easier. Over the last 20 years, a decrease in the incidence and mortality of stroke has been observed in Western countries. In contrast, in Dijon, which has the only population-based stroke registry in France, stable incidence rates have been reported. However, over the same period, age at stroke onset has risen by five years in men and eight years in women, which is probably related to both population aging and improvements in primary prevention and general health. The reported decrease in case-fatality rates suggests better acute management of stroke patients, and explains in part the increase in the prevalence of stroke. In addition, the assessment of vascular risk factors has demonstrated that high blood pressure remains the principal risk factor for both ischemic and hemorrhagic stroke, and that antihypertensive treatment is able to reduce stroke incidence. PERSPECTIVES Epidemiology studies could make it possible to measure the impact of new therapeutic strategies applied in both primary and secondary prevention. CONCLUSION Prevention, diagnosis, and acute treatment of stroke have considerably improved, but cerebrovascular diseases together with myocardial infarction remain the leading cause of death. Despite the absence of a rise in the incidence of stroke, its prevalence has increased. This is due to the decrease in case-fatality rates. As a consequence, there is an urgent need to organize health networks around stroke. Moreover, the rise in stroke-free life expectancy is a positive finding that reflects improvements in prevention.

Apport de l’évaluation écologique des troubles exécutifs dans la sclérose en plaques

Resume Introduction La sclerose en plaques (SEP) est la maladie neurologique invalidante du sujet jeune la plus frequente. La prevalence des troubles cognitifs est de 40 a 65 p. 100 dans la SEP. Les troubles cognitifs sont la deuxieme cause de handicap et sont a l’origine d’une alteration de la qualite de vie chez un grand nombre de patients. L’evaluation de ces troubles est souvent prise en defaut par les examens psychometriques habituels. Objectifs L’objectif principal de notre etude etait d’apprecier la sensibilite d’un test ecologique par rapport aux tests psychometriques standards dans l’evaluation des troubles executifs de la SEP. Methodes Vingt sujets porteurs d’une SEP cliniquement certaine ont ete apparies en âge, sexe, lateralite manuelle et niveau intellectuel pre-morbide a 20 sujets volontaires sains. Les performances psychometriques executives des 2 groupes ont ete comparees. L’ensemble des performances a ces tests formait un score composite (SFE). Le test ecologique utilise etait le test des commissions sous sa forme « papier-crayon ». Resultats Les performances psychometriques des sujets SEP etaient heterogenes et significativement diminuees pour le test des fluences alphabetiques (p = 0,01) et pour le test des commissions (p = 0,01). Il existait un lien significatif entre les performances au test des commissions et le score SFE (p = 0,009). Conclusions Les performances au test des commissions sont sensibles pour l’evaluation des troubles executifs et leur correlation avec le score global des fonctions executives evalue par la psychometrie est forte. Le test de commissions est plus sensible que la psychometrie classique dans l’evaluation des fonctions executives chez les sujets SEP. Nous proposons de completer l’evaluation psychometrique avec ce test lorsque celle-ci s’avere normale alors que le patient se plaint de difficultes cognitives.

Consultation après un infarctus ou un hématome cérébral

Points essentiels L’hypertension arterielle est le 1 er facteur de risque d’infarctus et d’hematome cerebral. Le cerveau est la 1 re cible de l’hypertension arterielle . Le cerveau est la 1 re cible des medicaments antihypertenseurs. Le controle de l’hypertension associe a l’arret du tabagisme reduit de 40 % le risque d’infarctus cerebral. Objectifs d’une consultation apres un infarctus ou un hematome cerebral : validation du diagnostic d’infarctus ou d’hematome cerebral et de sa cause ;identification des facteurs de risque de recidives de l’infarctus cerebral, mais aussi de l’infarctus du myocarde et de l’arteriopathie des membres inferieurs ;mise en place du traitement des facteurs de risque de recidives ;mise en place de la prevention des complications de l’atherothrombose et des cardiopathies emboligenes ;identification des complications de l’infarctus et de l’hematome cerebral.