Lemlih Ouchchane

Impact of the motor complications of Parkinson's disease on the quality of life

The impact of motor complications of Parkinsons disease (PD), especially levodopa‐induced dyskinesias, on quality of life (QL) was studied in 143 patients with PD. All were evaluated on the Hoehn and Yahr (H&Y) scale, and the Motor part of the Unified Parkinsons Disease Rating Scale (UPDRS). Motor complications were analyzed using the UPDRS Parts IVA and IVB and the Abnormal Involuntary Movement Scale. A specific Parkinsons disease quality of life questionnaire (39‐item version, PDQ‐39) was used. Motor complications significantly worsened the PDQ‐39 Summary Index (PDQ‐SI) of patients with PD. The dimensions of Mobility, Activities of Daily Living, Stigma, and Communication were the most strongly affected. “Peak dose” dyskinesia decreased Mobility, Emotional Well‐Being, and Cognition, whereas biphasic dyskinesia affected Mobility, Stigma, Communication, and Activities of Daily Living. Morning akinesia, end‐of‐dose fluctuations, and “unpredictable offs” decreased QL on the dimensions of Mobility, Activities of Daily Living, Stigma, and Communication. Nocturnal akinesia led to a deterioration of all dimensions of the PDQ‐39. Thus, motor complications and especially nocturnal akinesia and biphasic dyskinesias worsened the QL of PD patients.

Is R2* a New MRI Biomarker for the Progression of Parkinson’s Disease? A Longitudinal Follow-Up

Purpose To study changes of iron content in basal ganglia in Parkinson’s disease (PD) through a three-year longitudinal follow-up of the effective transverse relaxation rate R2*, a validated MRI marker of brain iron content which can be rapidly measured under clinical conditions. Methods Twenty-seven PD patients and 26 controls were investigated by a first MRI (t0). Longitudinal analysis was conducted among the 18 controls and 14 PD patients who underwent a second MRI (t1) 3 years after. The imaging protocol consisted in 6 gradient echo images obtained at different echo-times for mapping R2*. Quantitative exploration of basal ganglia was performed by measuring the variation of R2* [R2*(t1) – R2*(t0)] in several regions of interest. Results During the three-year evolution of PD, R2* increased in Substantia nigra (SN) (by 10.2% in pars compacta, p = 0.001, and 8.1% in pars reticulata, p = 0.013) and in the caudal putamen (11.4%, p = 0.011), without significant change in controls. Furthermore, we showed a positive correlation between the variation of R2* and the worsening of motor symptoms of PD (p = 0.028). Conclusion Significant variation of R2* was longitudinally observed in the SN and caudal putamen of patients with PD evolving over a three-year period, emphasizing its interest as a biomarker of disease progression. Our results suggest that R2* MRI follow-up could be an interesting tool for individual assessment of neurodegeneration due to PD, and also be useful for testing the efficiency of disease-modifying treatments.

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.

Brain mapping in stereotactic surgery: A brief overview from the probabilistic targeting to the patient-based anatomic mapping

In this article, we briefly review the concept of brain mapping in stereotactic surgery taking into account recent advances in stereotactic imaging. The gold standard continues to rely on probabilistic and indirect targeting, relative to a stereotactic reference, i.e., mostly the anterior (AC) and the posterior (PC) commissures. The theoretical position of a target defined on an atlas is transposed into the stereotactic space of a patients brain; final positioning depends on electrophysiological analysis. The method is also used to analyze final electrode or lesion position for a patient or group of patients, by projection on an atlas. Limitations are precision of definition of the AC-PC line, probabilistic location and reliability of the electrophysiological guidance. Advances in MR imaging, as from 1.5-T machines, make stereotactic references no longer mandatory and allow an anatomic mapping based on an individual patients brain. Direct targeting is enabled by high-quality images, an advanced anatomic knowledge and dedicated surgical software. Labeling associated with manual segmentation can help for the position analysis along non-conventional, interpolated planes. Analysis of final electrode or lesion position, for a patient or group of patients, could benefit from the concept of membership, the attribution of a weighted membership degree to a contact or a structure according to its level of involvement. In the future, more powerful MRI machines, diffusion tensor imaging, tractography and computational modeling will further the understanding of anatomy and deep brain stimulation effects.

Anatomy of the human thalamus based on spontaneous contrast and microscopic voxels in high-field magnetic resonance imaging.

BACKGROUND Since the pioneering studies of human thalamic anatomy based on histology and binding techniques, little new work has been done to bring this knowledge into clinical practice. OBJECTIVE With the advent of magnetic resonance imaging (MRI) we hypothesized that it was possible, in vitro, to make use of high spontaneous MRI contrasts between white and grey matter to directly identify the subcompartmentalisation of the thalamus. METHODS An anatomic specimen was imaged at high field (4.7 T) (basal ganglia plus thalamus block; 3-dimensional (3D) T1-weighted spin echo sequence; matrix, 256 × 256 × 256; isotropic voxel, 0.250 mm/edge; total acquisition time, 14 hours 30 minutes). Nuclei were manually contoured on the basis of spontaneous contrasted structures; labeling relied on 3D identification from classic knowledge; stereotactic location of centers of nuclei was computed. RESULTS Almost all intrathalamic substructures, nuclei, and white matter laminae were identified. Using 3D analysis, a simplified classification of intrathalamic nuclei into 9 groups was proposed, based on topographic MRI anatomy, designed for clinical practice: anterior (oral), posterior, dorsal, intermediate, ventral, medial, laminar, superficial, and related (epi and metathalamus). The overall 4.7-T anatomy matches that presented in the atlases of Schaltenbrand and Bailey (1959), Talairach et al (1957), and Morel et al (1997). CONCLUSION It seems possible to identify the subcompartments of the thalamus by spontaneous MRI contrast, allowing a tissue architectural approach. In addition, the MRI tissue architecture matches the earlier subcompartmentalization based on cyto- and chemoarchitecture. This true 3D anatomic study of the thalamus may be useful in clinical neuroscience and neurosurgical applications.

Risk factors for recurrence of venous thromboembolism associated with the use of oral contraceptives

BACKGROUND Combined oral contraceptives (COC) increase the risk of venous thromboembolism (VTE), but the risk of recurrent VTE is not precisely determined. In this retrospective cohort study, we sought the risk factors for recurrence after a first VTE that occurred in women taking COC. STUDY DESIGN Time-to-event analysis was done with Kaplan-Meier estimates. In total, 172 patients were included (43% with pulmonary embolism): 82% had no other clinical risk factor for VTE. RESULTS Among the 160 patients who stopped anticoagulation, the cumulative incidence of recurrent VTE was 5.1% after 1 year and 14.2% after 5 years. Significant factors associated with recurrence were renewed use of COC [hazard ratio (HR)=8.2 (2.1-32.2)], antiphospholipid syndrome [HR=4.1 (1.3-12.5)] and protein C deficiency or factor II G20210A [HR=2.7 (1.1-7)]. Pure-progestin contraception [HR=1.3 (0.5-3.0)] or factor V Leiden [HR=1.3 (0.5-3.4)] did not increase recurrence. Postsurgical VTE had a lower risk of recurrence [HR=0.1 (0.0-0.9)]. CONCLUSION Further studies are warranted to determine whether testing for antiphospholipid syndrome, protein C deficiency or the factor II G20210A could modify the duration of anticoagulation. This study confirms the safety of pure-progestin contraception.

Migraine headaches and pain with neuropathic characteristics: Comorbid conditions in patients with multiple sclerosis

Summary Thirty‐two percent of patients with multiple sclerosis experience both migraine and pain with neuropathic characteristics. These two symptoms are mediated by different mechanisms. Abstract We conducted a postal survey to assess the prevalence and characteristics of neuropathic pain and migraine in a cohort of multiple sclerosis (MS) patients. Of the 1300 questionnaires sent, 673 could be used for statistical analysis. Among the respondents, the overall pain prevalence in the previous month was 79%, with 51% experiencing pain with neuropathic characteristics (NCs) and 46% migraine. MS patients with both migraine and NC pain (32% of the respondents) reported more severe pain and had lower health‐related quality of life than MS patients with either migraine or NC pain. Pain intensity in MS patients with migraine was moderate (6.0 ± 0.1). Migraine was mostly episodic, but headaches were occurring on ≥15 days per month in 15% of those with migraine. MS patients with migraine were younger and had shorter disease durations than those with NC pain. NC pain was most often located in the extremities, back and head, and was frequently described as tingling and pins‐and‐needles. The intensity of NC pain was low to moderate (4.9 ± 0.1), but positively correlated with the number of painful body sites. Nonetheless, patients with NC pain were more disabled (with a higher Expanded Disability Status Scale and pain interference index) than patients with migraine. Migraine, but not NC pain, was associated with age, disease duration, relapsing‐remitting course, and interferon‐beta treatment. This suggests that NC pain and migraine are mediated by different mechanisms. Therefore, pain mechanisms that specifically operate in MS patients need to be characterized to design optimal treatments for these individuals.

Hypersexuality and pathological gambling in Parkinson's disease: A cross-sectional case–control study†‡§

Substance and behavioral addictions have already been described separately or in combination in Parkinsons disease. However, no comparisons of the prevalence of addictive behaviors in patients with Parkinsons disease and the general population have been published. The objective of this study was to compare the prevalence and characteristics of addictions (gambling, hypersexuality, tobacco, and alcohol) in patients with Parkinsons disease and in a matched, paired sample from the general population.

Comparative analysis of neointimal coverage with paclitaxel and zotarolimus drug-eluting stents, using optical coherence tomography 6 months after implantation

BACKGROUND Intrastent thrombosis, while rare, has a poor prognosis. Strut non-coverage is one causal factor, especially in cases of resistance to or premature discontinuation of dual antiplatelet therapy. AIM To compare neointimal coverage with paclitaxel and zotarolimus drug-eluting stents, using optical coherence tomography (OCT). METHODS Twenty-two drug-eluting stents (11 paclitaxel-eluting stents and 11 zotarolimus-eluting stents) were examined by OCT, 6 months after implantation. Mean neointimal strut-coverage thickness and percentage neointimal hyperplasia were measured every millimetre. On each OCT image, struts were classified into one of four categories: well-apposed to vessel wall with apparent neointimal coverage; well-apposed to vessel wall without neointimal coverage; malapposed to the vessel wall; or located on a major side branch. RESULTS OCT analysis showed a lower percentage of neointimal hyperplasia with paclitaxel-eluting stents than with zotarolimus-eluting stents (17% vs 38% and mean thickness 154 microm vs 333 microm, respectively; p<0.0001). The rate of strut-coverage was greater with zotarolimus-eluting stents than with paclitaxel-eluting stents (99.1% vs 87.1%, respectively; p<0.0001). A non-covered/covered strut ratio greater than 0.3 was observed in 0.5% of zotarolimus-eluting stent OCT images compared with 18% of paclitaxel-eluting stent OCT images (p<0.0001). CONCLUSION Six months after implantation, neointimal hyperplasia was greater with zotarolimus-eluting stents compared with paclitaxel-eluting stents. Conversely, neointimal strut-coverage was better with zotarolimus-eluting stents.

General Practitioners’ Barriers to Physical Activity Negatively Influence Type 2 Diabetic Patients’ Involvement in Regular Physical Activity

It is widely accepted that physical activity is a central component of type 2 diabetes management; HbA1c can be lowered by 0.6–0.8%, independent of changes in BMI and fat mass (1,2). However, incorporating regular physical activity into type 2 diabetes patients’ daily lives remains challenging. General practitioners (GPs) are cited as the primary source of information influencing healthy lifestyle decisions, but few studies have evaluated whether GPs’ perceived barriers toward physical activity affect physical activity uptake in diabetes patients (3). The objective of this study was to assess the associations between GPs’ perceived barriers to prescribing physical activity and type 2 diabetes patients’ perceived barriers to adopting physical activity. We conducted a cross-sectional study on GPs and their type 2 diabetes patients in the Auvergne region (France) through a self-administered …