Philippe Duverger

Psychiatric and Psychologic Impact of Surgery While Awake in Children for Resection of Brain Tumors

BACKGROUND Intraoperative direct stimulation during surgery while awake is considered to be the gold standard for identifying eloquent cortical sites. Only a few studies have referenced the psychologic impact of this event in the pediatric population. OBJECTIVE The aim of this clinical study is to present the psychologic aspects of surgery while awake in children. We question the psychiatric contraindications and age limits, as well as the impact on children, with particular attention to the psychologic conditioning and experience of these patients. METHODS Seven patients aged 8-16 years old with brain lesions were operated on while awake between 2008 and 2015. Data collected included perception and memories of surgery and diagnosis and also their real-life experience after surgery. Symptoms of posttraumatic stress disorder or acute stress were investigated. RESULTS None of the children had initial psychiatric problems. No psychiatric diagnosis was made before surgery. The child psychiatrist did not contraindicate any child for this procedure. Patients experienced little anticipatory anxiety. No child presented symptoms of posttraumatic stress disorder or acute stress. CONCLUSIONS The results are encouraging, allowing us to contemplate using brain surgery while awake for children without particular worries about the psychologic aspect.

Rationale and protocol for using a smartphone application to study autism spectrum disorders: SMARTAUTISM

Introduction Longitudinal studies on the evolution of autism spectrum disorder (ASD) symptoms are limited and have primarily used repeated measurements performed several months apart. However, measurements of changes in everyday life should more closely reflect the ‘real life’ of the patient and his or her family. We propose to study the childs ASD symptoms and their effect on the quality of life, psychological status and anxiety of the childs parents over a 6-month period using SMARTAUTISM, a smartphone application. Method and analysis This is a prospective, longitudinal, exploratory, open study with a 6-month follow-up period. Data will be recorded longitudinally over multiple weeks under natural conditions. The factors affecting the quality of life and anxiety of parents of children with ASD and the childrens functional symptoms will be examined, and the feasibility of using a smartphone application designed for parents of ASD patients will be assessed. Primary objective: Explore the evolution of a childs behaviour over 6 months and the (psychological and social) effects of these changes on the family. Secondary objective: Assess the feasibility of our application by examining the filling rate and application usage by parents for 6 months. 100 families containing 1 child diagnosed with ASD will be included. At baseline, sociodemographic, psychiatric and medical data will be recorded. The correlations of the general epidemiological variables (primary outcome measure) will be evaluated via multivariate analysis. The application filling rate (relative to the ideal filling rate) will be used to assess the feasibility of the application (secondary outcome measure). Ethics and dissemination The SMARTAUTISM study has the approval of the local ethics committee, and data security will be ensured via the use of encryption and a secure medical server. The use of this application will be proposed at autism resource centres across France.

L’avenir n’est pas écrit

Nous relatons l’histoire de Louise, une petite fille differente rencontree en consultation et pour qui les questions de transmission, sous toutes ses formes, sont au coeur de son histoire : entre transmission et determination (avec la question de l’inne et de l’acquis), transmission et prediction (et de certains enjeux du diagnostic prenatal), transmission et predestination (avec la question du diagnostic precoce), transmission et information au patient ou sa famille (sous-couvert de la loi de 2002), transmission et narration (dans la rencontre avec l’enfant). Dans ces debats, le pedopsychiatre de liaison en maternite et en service de pediatrie a une place fondamentale, en tant que praticien de l’inattendu et artisan de la rencontre avec l’enfant et ses parents.