Bruno Oquendo - Academia.edu (original) (raw)

Papers by Bruno Oquendo

Annales françaises de médecine d’urgence, 2018

Journal of Clinical Medicine, 2021

Background: We wanted to better understand the frequency and temporal distribution of symptoms of... more Background: We wanted to better understand the frequency and temporal distribution of symptoms of COVID-19 in very old patients, which are currently not well defined. Methods: In an observational, descriptive study, we followed all patients being at three geriatric convalescence and rehabilitation units when a COVID-19 outbreak emerged in those units in March 2020. For those who developed the disease, we recorded any new symptom occurring at diagnosis, in the previous 14 and the following 21 days. A group of SARS-Cov-2-negative patients served as controls. Results: Sixty-nine of the 176 inpatients (mean age: 86 years) were infected by SARS-Cov-2 during the outbreak. At the moment of diagnosis, a majority of patients had fever (71.0%), malaise-asthenia (24.6%), or respiratory symptoms (66.7%). However, 48 patients (69.6% of all SARS-Cov-2 positive patients) also presented, usually several days before, other symptoms: (a) gastrointestinal symptoms (39.1% of all patients, median onset ...

JAMA Network Open, 2021

IMPORTANCE There is evidence of central nervous system impairments associated with coronavirus di... more IMPORTANCE There is evidence of central nervous system impairments associated with coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Multimodal monitoring of patients with COVID-19 may delineate the specific features of COVID-19-related encephalopathy and guide clinical management. OBJECTIVES To investigate clinical, biological, and brain magnetic resonance imaging (MRI) findings in association with electroencephalographic (EEG) features for patients with COVID-19, and to better refine the features of COVID-19-related encephalopathy. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study conducted in Pitié-Salpêtrière Hospital, Paris, France, enrolled 78 hospitalized adults who received a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) and underwent EEG between March 30 and June 11, 2020. EXPOSURES Detection of SARS-CoV-2 from a nasopharyngeal specimen using a reverse transcription-polymerase chain reaction assay or, in the case of associated pneumonia, on a computed tomography scan of the chest. MAIN OUTCOMES AND MEASURES Data on the clinical and paraclinical features of the 78 patients with COVID-19 were retrieved from electronic patient records. RESULTS Of 644 patients who were hospitalized for COVID-19, 78 (57 men [73%]; mean [SD] age, 61 [12] years) underwent EEG. The main indications for EEG were delirium, seizure-like events, and delayed awakening in the intensive care unit after stopping treatment with sedatives. Sixty-nine patients showed pathologic EEG findings, including metabolic-toxic encephalopathy features, frontal abnormalities, periodic discharges, and epileptic activities. Of 57 patients who underwent brain MRI, 41 showed abnormalities, including perfusion abnormalities, acute ischemic lesions, multiple microhemorrhages, and white matter-enhancing lesions. Fifty-five patients showed biological abnormalities, including dysnatremia, kidney failure, and liver dysfunction, the same day as the EEG. The results of cerebrospinal fluid analysis were negative for SARS-Cov-2 for all tested patients. Nine patients who had no identifiable cause of brain injury outside COVID-19 were further isolated; their brain injury was defined as COVID-19-related encephalopathy. They represented 1% (9 of 644) of patients with COVID-19 requiring hospitalization. Six of these 9 patients had movement disorders, 7 had frontal syndrome, 4 had brainstem impairment, 4 had periodic EEG discharges, and 3 had MRI white matter-enhancing lesions. (continued) Key Points Question Can electroencephalography (EEG), combined with clinical, biological, and magnetic resonance imaging (MRI) analyses, help to better characterize patients with neurologic coronavirus disease 2019 (COVID-19) and diagnose specific COVID-19-related encephalopathy? Findings Neurologic manifestations, biological findings, EEG findings, and brain MRI images were analyzed in a cohort study of 78 adult patients with COVID-19. Nine patients had no identified cause of brain injury, as revealed by biological and MRI findings; their injury was defined as COVID-19related encephalopathy. Meaning This study suggests that, although neurologic manifestations, EEG findings, and MRI findings may appear heterogeneous and nonspecific, multimodal monitoring may better identify patients with COVID-19-related encephalopathy and guide treatment strategy.

European Journal of Nuclear Medicine and Molecular Imaging, 2021

Purpose Little is known about the neuronal substrates of neuropsychiatric symptoms associated wit... more Purpose Little is known about the neuronal substrates of neuropsychiatric symptoms associated with COVID-19 and their evolution during the course of the disease. We aimed at describing the longitudinal brain metabolic pattern in COVID-19related encephalopathy using 18F-FDG-PET/CT. Methods Seven patients with variable clinical presentations of COVID-19-related encephalopathy were explored thrice with brain 18F-FDG-PET/CT, once in the acute phase, 1 month later and 6 months after COVID-19 onset. PET images were analysed with voxel-wise and regions-of-interest approaches in comparison with 32 healthy controls. Results Patients' neurological manifestations during acute encephalopathy were heterogeneous. However, all of them presented with predominant cognitive and behavioural frontal disorders. SARS-CoV-2 RT-PCR in the CSF was negative for all patients. MRI revealed no specific abnormalities for most of the subjects. All patients had a consistent pattern of hypometabolism in a widespread cerebral network including the frontal cortex, anterior cingulate, insula and caudate nucleus. Six months after COVID-19 onset, the majority of patients clinically had improved but cognitive and emotional disorders of varying severity remained with attention/executive disabilities and anxio-depressive symptoms, and lasting prefrontal, insular and subcortical 18F-FDG-PET/CT abnormalities. Conclusion The implication of this widespread network could be the neural substrate of clinical features observed in patients with COVID-19, such as frontal lobe syndrome, emotional disturbances and deregulation of respiratory failure perception. This study suggests that this network remains mildly to severely impaired 6 months after disease onset.

ObjectiveTo describe the spectrum of neurological and psychiatric complications in patients with ... more ObjectiveTo describe the spectrum of neurological and psychiatric complications in patients with Covid-19 seen in a multidisciplinary center over six months.MethodsWe conducted a retrospective, observational study on all patients showing neurological or psychiatric symptoms in the context of Covid-19 seen in the Department of Neurology and Psychiatry of the APHP-Sorbonne University. We collected demographic data, medical and treatment history, comorbidities, symptoms, date of onset, and severity of Covid-19 infection, neurological and psychiatric symptoms, neurological and psychiatric examination data and, when available, results from cerebrospinal fluid (CSF) analysis, brain magnetic resonance (MRI) imaging, 18-fluorodesoxyglucose-position emission computed tomography (FDG-PET/CT)), electroencephalography (EEG) and electroneuromyography (ENMG).Results245 patients were included in the analysis. One-hundred fourteen patients (47%) were admitted to the intensive care unit (ICU) and 10...

European Journal of Neurology, 2020

The aim of this paper is to describe the clinical features of COVID‐19‐related encephalopathy and... more The aim of this paper is to describe the clinical features of COVID‐19‐related encephalopathy and their metabolic correlates using brain 2‐desoxy‐2‐fluoro‐D‐glucose (FDG)‐positron‐emission tomography (PET)/computed tomography (CT) imaging.

NPG Neurologie - Psychiatrie - Gériatrie, 2021

Resume La prevalence de la maladie de Parkinson est d’environ 1 % chez les sujets âges de plus de... more Resume La prevalence de la maladie de Parkinson est d’environ 1 % chez les sujets âges de plus de 65 ans et de 4 % chez les plus de 80 ans. La maladie de Parkinson est responsable d’un handicap grave apres 10 a 15 ans de progression. La plupart des patients atteints de maladie de Parkinson vus en geriatrie ont une maladie de Parkinson a debut tardif (ayant debute apres l’âge de 60 ans) et ayant une longue evolution. Les symptomes augmentent a mesure que la maladie progresse dont les symptomes cardinaux (tremblement de repos, bradykinesie, rigidite, instabilite posturale). La reponse a la L-dopa devient moins bonne au fil du temps. Comment detecter et prendre en charge ces patients âges parkinsoniens ? Le diagnostic demeure essentiel avec ses trois etapes : mettre en evidence le syndrome parkinsonien, eliminer les diagnostics differentiels et y ajouter d’autres elements positifs (asymetries persistantes, symptomes cardinaux, reponse a la L-dopa). La iatrogenie, en particulier avec les neuroleptiques, et la demence a corps de Lewy sont des diagnostics differentiels importants. L’evolution tardive de la maladie comprend des troubles de la demarche et une eventuelle atteinte cognitive. Les symptomes dysautonomiques sont domines par l’hypotension orthostatique et la constipation. Les fluctuations et la dyskinesie motrice sont tres frequentes et restent un defi pour le traitement. Le traitement pharmacologique repose sur la L-dopa, et le recours aux autres molecules disponibles est base sur une evaluation fine de la balance benefice-risque. Enfin, le traitement non pharmacologique necessite de la readaptation et la prise en charge de la perte d’autonomie. La neurochirurgie fonctionnelle n’est pas indiquee dans cette population.

Pathy's Principles and Practice of Geriatric Medicine

Brain Communications

A variety of neuropsychiatric complications has been described in association with COVID-19 infec... more A variety of neuropsychiatric complications has been described in association with COVID-19 infection. Large scale studies presenting a wider picture of these complications and their relative frequency are lacking. The objective of our study was to describe the spectrum of neurological and psychiatric complications in patients with COVID-19 seen in a multidisciplinary hospital centre over 6 months. We conducted a retrospective, observational study of all patients showing neurological or psychiatric symptoms in the context of COVID-19 seen in the medical and university neuroscience department of Assistance Publique Hopitaux de Paris—Sorbonne University. We collected demographic data, comorbidities, symptoms and severity of COVID-19 infection, neurological and psychiatric symptoms, neurological and psychiatric examination data and, when available, results from CSF analysis, MRI, EEG and EMG. A total of 249 COVID-19 patients with a de novo neurological or psychiatric manifestation were...

JAMA Network Open

IMPORTANCE Coronavirus disease 2019 (COVID-19) is a major threat to nursing homes. During the COV... more IMPORTANCE Coronavirus disease 2019 (COVID-19) is a major threat to nursing homes. During the COVID-19 pandemic wave that hit France in March and April 2020, staff members of some French nursing homes decided to confine themselves with their residents on a voluntary basis to reduce the risk of entry of the severe acute respiratory syndrome coronavirus 2 into the facility. OBJECTIVE To investigate COVID-19-related outcomes in French nursing homes that implemented voluntary staff confinement with residents. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted in French nursing homes from March 1 to May 11, 2020. Participants included residents and staff members of the nursing homes where staff participated in voluntary self-confinement as well as those of the facilities for elderly people where staff did not practice self-confinement. Rates of COVID-19 cases and mortality in the cohort of nursing homes with self confinement were compared with those derived from a population-based survey of nursing homes conducted by French health authorities. EXPOSURES Nursing homes with staff who self-confined were identified from the media and included if the confinement period of staff with residents was longer than 7 days. MAIN OUTCOMES AND MEASURES Mortality related to COVID-19 among residents and COVID-19 cases among residents and staff members. COVID-19 was diagnosed by primary care or hospital physicians on the basis of fever and respiratory signs (eg, cough, dyspnea) or a clinical illness compatible with COVID-19; COVID-19 diagnoses were considered confirmed if real-time reverse transcriptase-polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 on nasopharyngeal swab was positive and considered possible if the test had not been performed or results were negative. Cases of COVID-19 were recorded by a telephone interview with the directors of nursing homes with staff who self-confined and by a nationwide declaration survey to health authorities for all facilities. RESULTS This study included 17 nursing homes in which 794 staff members confined themselves to the facility with their 1250 residents. The national survey included 9513 facilities with 385 290 staff members and 695 060 residents. Only 1 nursing home with staff who self-confined (5.8%) had cases of COVID-19 among residents, compared with 4599 facilities in the national survey (48.3%) (P < .001). Five residents (0.4%) in the nursing homes with staff who self-confined had confirmed COVID-19, compared with 30 569 residents (4.4%) with confirmed COVID-19 in the national survey (P < .001); no residents of facilities with self-confinement had possible COVID-19, compared with 31 799 residents (4.6%) with possible COVID-19 in the national survey (P < .001). Five residents (0.4%) in the nursing homes with staff who self-confined died of COVID-19, compared with 12 516 (1.8%) in the national survey (odds ratio, 0.22; 95% CI, 0.09-0.53; P < .001). Twelve staff members (continued) Key Points Question Was self-confinement of staff members with residents in French nursing homes during the coronavirus disease 2019 (COVID-19) pandemic associated with better outcomes related to COVID-19 compared with overall national outcomes? Findings This cohort study including 17 nursing homes with staff selfconfinement and 9513 nursing homes in a national survey found that nursing homes with staff self-confinement experienced lower mortality related to COVID-19 among residents and lower incidence of COVID-19 among residents and staff members than rates recorded in a national survey. Meaning These findings suggest that self-confinement of nursing home staff members with residents may help protect residents from mortality related to COVID-19 and residents and staff from COVID-19 infection.