Caroline Moreau - Academia.edu (original) (raw)
Papers by Caroline Moreau
![Research paper thumbnail of [Gait disorders in Parkinson's disease: and pathophysiological approaches]](https://attachments.academia-assets.com/43914376/thumbnails/1.jpg)
](Revue Neurologique
Gait disorders and axial symptoms are the main therapeutic challenges in advanced Parkinson's... more Gait disorders and axial symptoms are the main therapeutic challenges in advanced Parkinson's disease (PD). Gait disorders in PD are characterized by spatial and temporal dysfunction. Gait hypokinesia is the first to appear and is responsible for the decrease in velocity. A good sensitivity to the levodopa is well established. Morris et al. [Morris ME, Iansek R, Matyas TA, Summers JJ. Ability to modulate walking cadence remains intact in Parkinson's disease. J Neurol Neurosurg Psychiatry 1994a;57(12):1532-4; Morris ME, Iansek R, Matyas TA, Summers JJ. The pathogenesis of gait hypokinesia in Parkinson's disease. Brain 1994b;117(Pt. 5):1169-81; Morris ME, Iansek R, Matyas TA, Summers JJ. Stride length regulation in Parkinson's disease. Brain 1996;119:551-68] demonstrated that the ability to modulate walking cadence remains intact in PD, and could correspond to a compensatory mechanism. More advanced disease stages of the disease are characterized by abnormal temporal p...
Revue Neurologique
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder of upper and lower motorneuro... more Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder of upper and lower motorneurons, leading to death in 3 to 5 years. Respiratory insufficiency and hypoxemia are closely linked during the clinical course of ALS. Chronic respiratory insufficiency and hypoxemia generally occur late in the disease course but rapid episodes of intermittent hypoxemia followed by reoxygenation can occur early and insidiously. Two pathways are involved in the response to hypoxemia: (i) hypoxia inducible factor-1 (HIF-1) and VEGF/HIF-2 and an erythropoietin (EPO) mediated pathway, in response to prolonged hypoxemia; and (ii) nuclear factor kappa-B (NFkappa-B) during acute hypoxemia followed by reoxygenation episodes, inducing inflammatory mediators: interleukin-6 (IL-6), TNF-alpha, cyclo oxygenase-2 (COX-2) and prostaglandin E-2 (PGE-2). Our aim was to specify the role of the different functional pathways of response to hypoxemia in sporadic ALS patients, compared with neurological controls...
BMC neurology, 2015
Growing body of evidence suggests that Parkinson's disease (PD) is associated with oxidative ... more Growing body of evidence suggests that Parkinson's disease (PD) is associated with oxidative damage via iron accumulation in the substantia nigra (SN). Low ceruloplasmin (CP)-ferroxidase activity has been identified in the SN and the cerebrospinal fluid (CSF) of patients with PD. The iron chelator, deferiprone, reduces the abnormally high levels of iron in the SN. In order to determine CP's involvement in iron accumulation in SN and PD progression, we aim to compare the ability of iron chelation treatment to reducing both SN iron levels and motor handicap in PD patients according to the level of ceruloplasmin activity. We used a moderate chelation protocol with deferiprone (DFP) based on a, 6-month delayed-start paradigm, randomized placebo controlled clinical trial in 40 PD patients. CP-ferroxidase activity was determined in blood and CSF together with the D544E gene polymorphism (rs701753). Iron levels were determined by R2* MRI sequence and the motor handicap by the UPDRS...
Journal of Parkinson's disease, Jan 16, 2015
Due to its high prevalence in dual-task paradigms, freezing of gait in Parkinson's disease is... more Due to its high prevalence in dual-task paradigms, freezing of gait in Parkinson's disease is thought to be associated with dysexecutive syndrome and attentional disorders. However, the role of specific attentional disorders in patients with freezing of gait is still unclear. Here, we sought to specifically determine which basic attentional modalities are impaired in patients with freezing of gait. Seventy-eight parkinsonian patients performed a computer-controlled reaction-time paradigm designed to measure the different attentional subcomponents, controlled for visuospatial processing and motor participation. The freezer (n = 42) and non-freezer (n = 36) groups were matched for age, educational level, MMSE and MDRS. There were no intergroup differences in simple reaction times, whereas choice reaction times were higher in the freezer group than in the non-freezer group for divided attention (p = 0.023). At equivalent levels of overall cognitive efficiency, freezer patients show...
Contraception, Jan 25, 2015
To describe contraceptive practices of men in a relationship in France, where use of female-contr... more To describe contraceptive practices of men in a relationship in France, where use of female-controlled methods is predominant, and to explore their involvement in managing contraception within the couple. Data are drawn from a national probability cross-sectional survey on sexual and reproductive health conducted in France in 2010. The study sample comprised 3,373 men aged 15-49, 1,776 of whom of whom were asked about their current contraceptive practices after they reported they were fecund and sexually active and did not currently want a child. Analyses were performed with logistic regression models. Few men aged 15-49 with a partner did not use contraception (3.4%). Most reported using only a female method (71.7%), 20.4% only cooperative methods, such as condoms, withdrawal, and the rhythm method, and 4.5% both. Among contraceptive users, withdrawal (7.7%) was more likely to be used by men with low incomes or low educational levels. Condom use was reported as a contraceptive meth...
Brain : a journal of neurology, Jan 23, 2015
After more than 50 years of treating Parkinson's disease with l-DOPA, there are still no guid... more After more than 50 years of treating Parkinson's disease with l-DOPA, there are still no guidelines on setting the optimal dose for a given patient. The dopamine transporter type 1, now known as solute carrier family 6 (neurotransmitter transporter), member 3 (SLC6A3) is the most powerful determinant of dopamine neurotransmission and might therefore influence the treatment response. We recently demonstrated that methylphenidate (a dopamine transporter inhibitor) is effective in patients with Parkinson's disease with motor and gait disorders. The objective of the present study was to determine whether genetic variants of the dopamine transporter type 1-encoding gene (SLC6A3) are associated with differences in the response to treatment of motor symptoms and gait disorders with l-DOPA and methylphenidate (with respect to the demographic, the disease and the treatment parameters and the other genes involved in the dopaminergic neurotransmission). This analysis was part of a mult...
Human reproduction (Oxford, England), 2015
What are the characteristics and circumstances of pregnancies men report as unintended in France?... more What are the characteristics and circumstances of pregnancies men report as unintended in France? Pregnancies reported as unintended were most prevalent among young men with insecure financial situations, less stable relationships and inconsistent use of contraception or false assumptions about their partner's use of contraception. Efforts to involve men in family planning have increased over the last decade; however, little is known about factors associated with men's pregnancy intentions and associated contraceptive behaviours. The data presented in this study were drawn from the nationally representative FECOND study, a population-based survey conducted in France in 2010. The sample comprised 8675 individuals (3373 men), aged 15-49 years, who responded to a telephone interview about socio-demographics and topics related to sexual and reproductive health. The total refusal rate was 20%. This study included 2997 men, of whom 664 reported 893 recent pregnancies (in the 5 yea...
Journal of Parkinson's disease, 2014
After several years duration of Parkinson's disease, with or without deep brain stimulation, ... more After several years duration of Parkinson's disease, with or without deep brain stimulation, axial signs (such as postural instability, freezing of gait) may worsen. High-voltage, low-frequency stimulation has been shown to improve severe gait disorders in some patients. To identify predictive factors for the efficacy of low-frequency stimulation. We assessed the respective effects of low- and high-frequency stimulation using an acute stand-walk- sit test, and on motor performance in 22 patients with longstanding, bilateral sub-thalamic nucleus stimulation. We calculated the difference in the number of steps (delta steps) between high and low -frequency stimulation during the stand-walk-sit test. Our aim was to establish a profile for low-frequency responders, which was defined by a positive value for delta steps. Low frequency responders presented higher age, a severe axial phenotype five years after surgery and a lower L-dopa responsiveness of (i) the Unified Parkinson's D...
Revue d'épidémiologie et de santé publique, 2003
Despite recent studies showing evidence that the organisation of the French health care system ra... more Despite recent studies showing evidence that the organisation of the French health care system raises some problems concerning access to abortion, far little is known on the reality of access conditions and the views of women on the difficulties they experience when they attend an abortion clinic. In this article, we discuss the complementarity of materials from two surveys one qualitative, the other quantitative in the study of patterns of care for an abortion. The qualitative survey included 51 women who reported a history of induced abortion, selected from a qualitative study on unintended pregnancy in France. The quantitative survey included 480 women, who had an abortion in the past 10 years. These women were selected from a representative sample of 2863 women aged 18 to 44, who participated in a study on contraception and abortion. The variety of patterns of care for an abortion, the rareness of dysfunctions in the health care system and the importance of the first professiona...
Les facteurs de risque associés au déclin de la fonction respiratoire dans l'asthme sont mal conn... more Les facteurs de risque associés au déclin de la fonction respiratoire dans l'asthme sont mal connus. Une étude longitudinale prospective et multicentrique d'une cohorte d'enfants asthmatiques vus en consultation spécialisée pour asthme a été mise en place en 2003. La sévérité était définie selon GINA 2004 et le contrôle de l'asthme évalué par le médecin était considéré optimal, acceptable ou inacceptable selon les critères de l'ANAES 2004. Les données ont été recueillies dans un questionnaire sous forme d'un logiciel informatique par un pneumologue pédiatre. À ce jour, 172 enfants de plus de 6 ans (médiane 9,15 ans ; ± 2,93 ans) ont été inclus. À l'inclusion, 30 enfants avaient un asthme intermittent et 142, un asthme persistant , 60 modérés et 16 sévères). Le VEMS moyen avant et après bronchodilatateur était de 93,15 ± 13,8 % et 98 ± 14,7 % respectivement ; la CVF moyenne avant et après bronchodilatateur était de 93 ± 12 % et 95,8 ± 11,8 %. Le gain après bronchodilatateur était d'autant plus important que l'asthme était moins bien contrôlé (p = 0,009) et plus sévère (p = 0,034). Ces résultats suggèrent d'inclure le degré de réversibilité des débits bronchiques dans la définition du contrôle et de la sévérité de l'asthme chez l'enfant. L'étude longitudinale de cette cohorte devrait permettre de préciser si le degré de réversibilité est un facteur de risque d'asthme plus grave au cours de l'évolution.
CONTEXT: Oral contraceptives are the most popular form of reversible contraception used in develo... more CONTEXT: Oral contraceptives are the most popular form of reversible contraception used in developed countries. Their efficacy depends on how consistently and correctly they are used.
Brain : a journal of neurology, 2014
Autosomal dominant cerebellar ataxia corresponds to a clinically and genetically heterogeneous gr... more Autosomal dominant cerebellar ataxia corresponds to a clinically and genetically heterogeneous group of neurodegenerative disorders that primarily affect the cerebellum. Here, we report the identification of the causative gene in spinocerebellar ataxia 21, an autosomal-dominant disorder previously mapped to chromosome 7p21.3-p15.1. This ataxia was firstly characterized in a large French family with slowly progressive cerebellar ataxia, accompanied by severe cognitive impairment and mental retardation in two young children. Following the recruitment of 12 additional young family members, linkage analysis enabled us to definitively map the disease locus to chromosome 1p36.33-p36.32. The causative mutation, (c.509C>T/p.P170L) in the transmembrane protein gene TMEM240, was identified by whole exome sequencing and then was confirmed by Sanger sequencing and co-segregation analyses. Index cases from 368 French families with autosomal-dominant cerebellar ataxia were also screened for mu...
Gait & Posture, 2014
Attentional resources appear to be involved in the occurrence of FoG. The Parkgait study recently... more Attentional resources appear to be involved in the occurrence of FoG. The Parkgait study recently reported that methylphenidate reduces gait hypokinesia and freezing of gait (FoG) in advanced PD patients receiving STN-DBS in the off-dopaminergic drug condition. Methylphenidate is considered to improve attention. The primary objective of the present ancillary study was to determine whether methylphenidate reduced the interference between a cognitive task and gait in patients with FoG. The study's secondary objective was to compare attentional performance in methylphenidate-treated and placebo-treated patients. A total of 24 patients (from two centers) were included in the study. Patients were randomly assigned 1:1 to a three-month course of methylphenidate (1mg/kg/day) or placebo. Patients were assessed after an acute L-dopa challenge. The primary outcome criterion was the stride length ratio ((dual-task stride length minus free gait stride length)/free gait stride length). Trials with FoG episodes were excluded from the analysis. Secondary outcomes included changes in reaction times for computerized attention tasks and FoG severity. When comparing patients receiving methylphenidate with those receiving placebo, we did not observe any significant differences in the interaction between the dual task and gait or in attentional performance. As in the main Parkgait study, methylphenidate did not reduce gait hypokinesia in patients receiving dopaminergic treatment. Our present results suggest that the reduction in the number of FoG episodes previously observed in patients on methylphenidate was neither due to interaction between a dual-task and gait nor an increase in attentional performance.
Pratique Neurologique - FMC, 2015
ABSTRACT La sclérose latérale amyotrophique (SLA) est une maladie neurodégénérative incurable, gr... more ABSTRACT La sclérose latérale amyotrophique (SLA) est une maladie neurodégénérative incurable, grave (médiane de survie de 24 mois après diagnostic), caractérisée par un dysfonctionnement rapidement progressif des motoneurones centraux et périphériques. Les formes cliniques diffèrent selon la localisation initiale du déficit moteur, la vitesse de la perte neuronale, le retentissement fonctionnel, et l’association ou non à des troubles psycho-comportementaux ou cognitifs. Le pronostic vital est conditionné par l’atteinte respiratoire et l’état nutritionnel. Il peut être amélioré par la mise en place rapide de toutes les stratégies thérapeutiques permettant de corriger les troubles nutritionnels, de compenser les troubles respiratoires, en particulier ceux du sommeil, de prévenir les fausses routes alimentaires, les chutes et les infections respiratoires, en respectant la volonté du malade. Une bonne collaboration du malade et de ses proches est nécessaire : elle dépend de la qualité de l’annonce du diagnostic et des informations faites par les médecins en veillant à respecter les mécanismes psychologiques d’adaptation à une maladie très anxiogène. La qualité de vie dépend des aides à la lutte contre le handicap et du soutien psychosocial adaptés à l’évolution de la maladie, en évoquant les problèmes pratiques du quotidien et la charge pour les proches, en particulier le conjoint qui est souvent le principal et parfois l’unique aidant naturel du malade. Cela demande une grande disponibilité des équipes soignantes et l’intervention coordonnée de professionnels de compétences complémentaires à l’hôpital comme au domicile : la lutte contre le handicap, la pneumologie, la nutrition, la psychologie et les soins palliatifs. La prise en charge de la phase avancée de la SLA (où la dépendance est totale et où l’atteinte respiratoire et l’état nutritionnel menacent la vie) soulève des questions éthiques difficiles sur l’autonomie décisionnelle du malade et la bienfaisance des traitements invasifs de soutien de la vie, en particulier la ventilation mécanique sur trachéotomie.
Neurology, 2005
Plasma and CSF from patients with ALS and control subjects were obtained with informed consent as... more Plasma and CSF from patients with ALS and control subjects were obtained with informed consent as part of the diagnostic evaluation or a research protocol (table). Neurologic controls included degenerative disorders: Parkinson disease (PD), supranuclear palsy, hydrocephaly, ...
Revue Neurologique
Gait disorders and axial symptoms are the main therapeutic challenges in advanced Parkinson's... more Gait disorders and axial symptoms are the main therapeutic challenges in advanced Parkinson's disease (PD). Gait disorders in PD are characterized by spatial and temporal dysfunction. Gait hypokinesia is the first to appear and is responsible for the decrease in velocity. A good sensitivity to the levodopa is well established. Morris et al. [Morris ME, Iansek R, Matyas TA, Summers JJ. Ability to modulate walking cadence remains intact in Parkinson's disease. J Neurol Neurosurg Psychiatry 1994a;57(12):1532-4; Morris ME, Iansek R, Matyas TA, Summers JJ. The pathogenesis of gait hypokinesia in Parkinson's disease. Brain 1994b;117(Pt. 5):1169-81; Morris ME, Iansek R, Matyas TA, Summers JJ. Stride length regulation in Parkinson's disease. Brain 1996;119:551-68] demonstrated that the ability to modulate walking cadence remains intact in PD, and could correspond to a compensatory mechanism. More advanced disease stages of the disease are characterized by abnormal temporal p...
Revue Neurologique
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder of upper and lower motorneuro... more Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder of upper and lower motorneurons, leading to death in 3 to 5 years. Respiratory insufficiency and hypoxemia are closely linked during the clinical course of ALS. Chronic respiratory insufficiency and hypoxemia generally occur late in the disease course but rapid episodes of intermittent hypoxemia followed by reoxygenation can occur early and insidiously. Two pathways are involved in the response to hypoxemia: (i) hypoxia inducible factor-1 (HIF-1) and VEGF/HIF-2 and an erythropoietin (EPO) mediated pathway, in response to prolonged hypoxemia; and (ii) nuclear factor kappa-B (NFkappa-B) during acute hypoxemia followed by reoxygenation episodes, inducing inflammatory mediators: interleukin-6 (IL-6), TNF-alpha, cyclo oxygenase-2 (COX-2) and prostaglandin E-2 (PGE-2). Our aim was to specify the role of the different functional pathways of response to hypoxemia in sporadic ALS patients, compared with neurological controls...
BMC neurology, 2015
Growing body of evidence suggests that Parkinson's disease (PD) is associated with oxidative ... more Growing body of evidence suggests that Parkinson's disease (PD) is associated with oxidative damage via iron accumulation in the substantia nigra (SN). Low ceruloplasmin (CP)-ferroxidase activity has been identified in the SN and the cerebrospinal fluid (CSF) of patients with PD. The iron chelator, deferiprone, reduces the abnormally high levels of iron in the SN. In order to determine CP's involvement in iron accumulation in SN and PD progression, we aim to compare the ability of iron chelation treatment to reducing both SN iron levels and motor handicap in PD patients according to the level of ceruloplasmin activity. We used a moderate chelation protocol with deferiprone (DFP) based on a, 6-month delayed-start paradigm, randomized placebo controlled clinical trial in 40 PD patients. CP-ferroxidase activity was determined in blood and CSF together with the D544E gene polymorphism (rs701753). Iron levels were determined by R2* MRI sequence and the motor handicap by the UPDRS...
Journal of Parkinson's disease, Jan 16, 2015
Due to its high prevalence in dual-task paradigms, freezing of gait in Parkinson's disease is... more Due to its high prevalence in dual-task paradigms, freezing of gait in Parkinson's disease is thought to be associated with dysexecutive syndrome and attentional disorders. However, the role of specific attentional disorders in patients with freezing of gait is still unclear. Here, we sought to specifically determine which basic attentional modalities are impaired in patients with freezing of gait. Seventy-eight parkinsonian patients performed a computer-controlled reaction-time paradigm designed to measure the different attentional subcomponents, controlled for visuospatial processing and motor participation. The freezer (n = 42) and non-freezer (n = 36) groups were matched for age, educational level, MMSE and MDRS. There were no intergroup differences in simple reaction times, whereas choice reaction times were higher in the freezer group than in the non-freezer group for divided attention (p = 0.023). At equivalent levels of overall cognitive efficiency, freezer patients show...
Contraception, Jan 25, 2015
To describe contraceptive practices of men in a relationship in France, where use of female-contr... more To describe contraceptive practices of men in a relationship in France, where use of female-controlled methods is predominant, and to explore their involvement in managing contraception within the couple. Data are drawn from a national probability cross-sectional survey on sexual and reproductive health conducted in France in 2010. The study sample comprised 3,373 men aged 15-49, 1,776 of whom of whom were asked about their current contraceptive practices after they reported they were fecund and sexually active and did not currently want a child. Analyses were performed with logistic regression models. Few men aged 15-49 with a partner did not use contraception (3.4%). Most reported using only a female method (71.7%), 20.4% only cooperative methods, such as condoms, withdrawal, and the rhythm method, and 4.5% both. Among contraceptive users, withdrawal (7.7%) was more likely to be used by men with low incomes or low educational levels. Condom use was reported as a contraceptive meth...
Brain : a journal of neurology, Jan 23, 2015
After more than 50 years of treating Parkinson's disease with l-DOPA, there are still no guid... more After more than 50 years of treating Parkinson's disease with l-DOPA, there are still no guidelines on setting the optimal dose for a given patient. The dopamine transporter type 1, now known as solute carrier family 6 (neurotransmitter transporter), member 3 (SLC6A3) is the most powerful determinant of dopamine neurotransmission and might therefore influence the treatment response. We recently demonstrated that methylphenidate (a dopamine transporter inhibitor) is effective in patients with Parkinson's disease with motor and gait disorders. The objective of the present study was to determine whether genetic variants of the dopamine transporter type 1-encoding gene (SLC6A3) are associated with differences in the response to treatment of motor symptoms and gait disorders with l-DOPA and methylphenidate (with respect to the demographic, the disease and the treatment parameters and the other genes involved in the dopaminergic neurotransmission). This analysis was part of a mult...
Human reproduction (Oxford, England), 2015
What are the characteristics and circumstances of pregnancies men report as unintended in France?... more What are the characteristics and circumstances of pregnancies men report as unintended in France? Pregnancies reported as unintended were most prevalent among young men with insecure financial situations, less stable relationships and inconsistent use of contraception or false assumptions about their partner's use of contraception. Efforts to involve men in family planning have increased over the last decade; however, little is known about factors associated with men's pregnancy intentions and associated contraceptive behaviours. The data presented in this study were drawn from the nationally representative FECOND study, a population-based survey conducted in France in 2010. The sample comprised 8675 individuals (3373 men), aged 15-49 years, who responded to a telephone interview about socio-demographics and topics related to sexual and reproductive health. The total refusal rate was 20%. This study included 2997 men, of whom 664 reported 893 recent pregnancies (in the 5 yea...
Journal of Parkinson's disease, 2014
After several years duration of Parkinson's disease, with or without deep brain stimulation, ... more After several years duration of Parkinson's disease, with or without deep brain stimulation, axial signs (such as postural instability, freezing of gait) may worsen. High-voltage, low-frequency stimulation has been shown to improve severe gait disorders in some patients. To identify predictive factors for the efficacy of low-frequency stimulation. We assessed the respective effects of low- and high-frequency stimulation using an acute stand-walk- sit test, and on motor performance in 22 patients with longstanding, bilateral sub-thalamic nucleus stimulation. We calculated the difference in the number of steps (delta steps) between high and low -frequency stimulation during the stand-walk-sit test. Our aim was to establish a profile for low-frequency responders, which was defined by a positive value for delta steps. Low frequency responders presented higher age, a severe axial phenotype five years after surgery and a lower L-dopa responsiveness of (i) the Unified Parkinson's D...
Revue d'épidémiologie et de santé publique, 2003
Despite recent studies showing evidence that the organisation of the French health care system ra... more Despite recent studies showing evidence that the organisation of the French health care system raises some problems concerning access to abortion, far little is known on the reality of access conditions and the views of women on the difficulties they experience when they attend an abortion clinic. In this article, we discuss the complementarity of materials from two surveys one qualitative, the other quantitative in the study of patterns of care for an abortion. The qualitative survey included 51 women who reported a history of induced abortion, selected from a qualitative study on unintended pregnancy in France. The quantitative survey included 480 women, who had an abortion in the past 10 years. These women were selected from a representative sample of 2863 women aged 18 to 44, who participated in a study on contraception and abortion. The variety of patterns of care for an abortion, the rareness of dysfunctions in the health care system and the importance of the first professiona...
Les facteurs de risque associés au déclin de la fonction respiratoire dans l'asthme sont mal conn... more Les facteurs de risque associés au déclin de la fonction respiratoire dans l'asthme sont mal connus. Une étude longitudinale prospective et multicentrique d'une cohorte d'enfants asthmatiques vus en consultation spécialisée pour asthme a été mise en place en 2003. La sévérité était définie selon GINA 2004 et le contrôle de l'asthme évalué par le médecin était considéré optimal, acceptable ou inacceptable selon les critères de l'ANAES 2004. Les données ont été recueillies dans un questionnaire sous forme d'un logiciel informatique par un pneumologue pédiatre. À ce jour, 172 enfants de plus de 6 ans (médiane 9,15 ans ; ± 2,93 ans) ont été inclus. À l'inclusion, 30 enfants avaient un asthme intermittent et 142, un asthme persistant , 60 modérés et 16 sévères). Le VEMS moyen avant et après bronchodilatateur était de 93,15 ± 13,8 % et 98 ± 14,7 % respectivement ; la CVF moyenne avant et après bronchodilatateur était de 93 ± 12 % et 95,8 ± 11,8 %. Le gain après bronchodilatateur était d'autant plus important que l'asthme était moins bien contrôlé (p = 0,009) et plus sévère (p = 0,034). Ces résultats suggèrent d'inclure le degré de réversibilité des débits bronchiques dans la définition du contrôle et de la sévérité de l'asthme chez l'enfant. L'étude longitudinale de cette cohorte devrait permettre de préciser si le degré de réversibilité est un facteur de risque d'asthme plus grave au cours de l'évolution.
CONTEXT: Oral contraceptives are the most popular form of reversible contraception used in develo... more CONTEXT: Oral contraceptives are the most popular form of reversible contraception used in developed countries. Their efficacy depends on how consistently and correctly they are used.
Brain : a journal of neurology, 2014
Autosomal dominant cerebellar ataxia corresponds to a clinically and genetically heterogeneous gr... more Autosomal dominant cerebellar ataxia corresponds to a clinically and genetically heterogeneous group of neurodegenerative disorders that primarily affect the cerebellum. Here, we report the identification of the causative gene in spinocerebellar ataxia 21, an autosomal-dominant disorder previously mapped to chromosome 7p21.3-p15.1. This ataxia was firstly characterized in a large French family with slowly progressive cerebellar ataxia, accompanied by severe cognitive impairment and mental retardation in two young children. Following the recruitment of 12 additional young family members, linkage analysis enabled us to definitively map the disease locus to chromosome 1p36.33-p36.32. The causative mutation, (c.509C>T/p.P170L) in the transmembrane protein gene TMEM240, was identified by whole exome sequencing and then was confirmed by Sanger sequencing and co-segregation analyses. Index cases from 368 French families with autosomal-dominant cerebellar ataxia were also screened for mu...
Gait & Posture, 2014
Attentional resources appear to be involved in the occurrence of FoG. The Parkgait study recently... more Attentional resources appear to be involved in the occurrence of FoG. The Parkgait study recently reported that methylphenidate reduces gait hypokinesia and freezing of gait (FoG) in advanced PD patients receiving STN-DBS in the off-dopaminergic drug condition. Methylphenidate is considered to improve attention. The primary objective of the present ancillary study was to determine whether methylphenidate reduced the interference between a cognitive task and gait in patients with FoG. The study's secondary objective was to compare attentional performance in methylphenidate-treated and placebo-treated patients. A total of 24 patients (from two centers) were included in the study. Patients were randomly assigned 1:1 to a three-month course of methylphenidate (1mg/kg/day) or placebo. Patients were assessed after an acute L-dopa challenge. The primary outcome criterion was the stride length ratio ((dual-task stride length minus free gait stride length)/free gait stride length). Trials with FoG episodes were excluded from the analysis. Secondary outcomes included changes in reaction times for computerized attention tasks and FoG severity. When comparing patients receiving methylphenidate with those receiving placebo, we did not observe any significant differences in the interaction between the dual task and gait or in attentional performance. As in the main Parkgait study, methylphenidate did not reduce gait hypokinesia in patients receiving dopaminergic treatment. Our present results suggest that the reduction in the number of FoG episodes previously observed in patients on methylphenidate was neither due to interaction between a dual-task and gait nor an increase in attentional performance.
Pratique Neurologique - FMC, 2015
ABSTRACT La sclérose latérale amyotrophique (SLA) est une maladie neurodégénérative incurable, gr... more ABSTRACT La sclérose latérale amyotrophique (SLA) est une maladie neurodégénérative incurable, grave (médiane de survie de 24 mois après diagnostic), caractérisée par un dysfonctionnement rapidement progressif des motoneurones centraux et périphériques. Les formes cliniques diffèrent selon la localisation initiale du déficit moteur, la vitesse de la perte neuronale, le retentissement fonctionnel, et l’association ou non à des troubles psycho-comportementaux ou cognitifs. Le pronostic vital est conditionné par l’atteinte respiratoire et l’état nutritionnel. Il peut être amélioré par la mise en place rapide de toutes les stratégies thérapeutiques permettant de corriger les troubles nutritionnels, de compenser les troubles respiratoires, en particulier ceux du sommeil, de prévenir les fausses routes alimentaires, les chutes et les infections respiratoires, en respectant la volonté du malade. Une bonne collaboration du malade et de ses proches est nécessaire : elle dépend de la qualité de l’annonce du diagnostic et des informations faites par les médecins en veillant à respecter les mécanismes psychologiques d’adaptation à une maladie très anxiogène. La qualité de vie dépend des aides à la lutte contre le handicap et du soutien psychosocial adaptés à l’évolution de la maladie, en évoquant les problèmes pratiques du quotidien et la charge pour les proches, en particulier le conjoint qui est souvent le principal et parfois l’unique aidant naturel du malade. Cela demande une grande disponibilité des équipes soignantes et l’intervention coordonnée de professionnels de compétences complémentaires à l’hôpital comme au domicile : la lutte contre le handicap, la pneumologie, la nutrition, la psychologie et les soins palliatifs. La prise en charge de la phase avancée de la SLA (où la dépendance est totale et où l’atteinte respiratoire et l’état nutritionnel menacent la vie) soulève des questions éthiques difficiles sur l’autonomie décisionnelle du malade et la bienfaisance des traitements invasifs de soutien de la vie, en particulier la ventilation mécanique sur trachéotomie.
Neurology, 2005
Plasma and CSF from patients with ALS and control subjects were obtained with informed consent as... more Plasma and CSF from patients with ALS and control subjects were obtained with informed consent as part of the diagnostic evaluation or a research protocol (table). Neurologic controls included degenerative disorders: Parkinson disease (PD), supranuclear palsy, hydrocephaly, ...