Jean Paul Nguyen - Academia.edu (original) (raw)
Papers by Jean Paul Nguyen
Multiple Sclerosis and Related Disorders
Neurophysiologie Clinique/Clinical Neurophysiology, 2016
A cote du traitement des mouvements anormaux, le traitement des douleurs chroniques represente un... more A cote du traitement des mouvements anormaux, le traitement des douleurs chroniques represente un chapitre important de la neurochirurgie fonctionnelle. Dans le domaine des douleurs dites par exces de nociception, dont la forme la plus typique est la douleur cancereuse, les interventions de section des voies de la douleur ont ete pratiquement remplacees par les traitements a base de morphine qui peuvent etre eventuellement administres par voie intrathecale. Le role de la neurochirurgie fonctionnelle s’est donc beaucoup restreint dans cette indication, d’autant plus que la plupart des « pompes intrathecales » sont placees par des medecins anesthesistes. Nous nous interesserons essentiellement au traitement des douleurs neuropathiques ou la neurochirurgie fonctionnelle est tres souvent sollicitee pour discuter de l’interet d’une technique de neuromodulation. Ces techniques que l’on denommait au debut de neurostimulation ont ete developpees il y a environ 40 ans, comme une application pratique de la theorie du « Gate control » de Wall et Melzack. L’idee etait que la stimulation electrique des fibres sensitives de gros diametre (fibres A-beta) pouvait inhiber la transmission du message douloureux qui emprunte les voies constituees par les fibres sensitives de petit diametre (fibres C). Les premieres applications ont ete de facon surprenante tres invasives puisqu’il s’agissait de stimuler le noyau ventro postero lateral (VPL) du thalamus, notamment pour le traitement des membres douloureux fantomes (G. Mazars, 1970). C’est aux environs de 1975 que s’est developpee la stimulation des cordons posterieurs de la moelle epiniere, appelee communement stimulation medullaire (SM). Contrairement a la stimulation du VPL, qui n’etait finalement pas tres efficace a moyen et long terme, la SM a eu rapidement un enorme succes. Elle s’etait, en effet, averee extremement efficace dans le traitement des sciatalgies neuropathiques rencontrees dans le cadre du « Failed Back Surgery Syndrome (FBSS) » actuellement denomme en francais par « echec de la chirurgie du bas du dos » par l’HAS (Haute Autorite de sante). L’intervention etait tres peu invasive lorsqu’elle etait realisee par voie percutanee, ce qui a indeniablement contribue a son succes. Certaines douleurs, comme celles qui etaient secondaires a un accident vasculaire cerebral, ne pouvaient cependant pas etre traitees par la SM. C’est en 1991 qu’un neurochirurgien japonais (Tsubokawa) a montre que la stimulation du cortex moteur pouvait ameliorer ce type de douleur. C’est ce principe qui a abouti au developpement de la stimulation magnetique transcrânienne (SMT) du cortex moteur pour le traitement des douleurs neuropathiques (1995). Le developpement le plus recent concerne la stimulation du nerf occipital, dont l’efficacite dans le traitement de la migraine suggere bien que l’action benefique de ces techniques est plus une modulation de circuits a priori « dysfonctionnels » qu’une neurostimulation de circuits deficients.
Douleurs : Evaluation - Diagnostic - Traitement, 2012
Actes du congrès de la SFETD, Lille, 21-24 novembre 2012 moyennée) et 35 % des patients se sont e... more Actes du congrès de la SFETD, Lille, 21-24 novembre 2012 moyennée) et 35 % des patients se sont estimés améliorer, et ce, quel que soit le bras. Conclusion.-Le bloc anesthésique pudendal reste indispensable au diagnostic. Les corticoïdes n'apportent pas de gain thérapeutique. Le traitement de référence reste la chirurgie.
Neuro-Chirurgie, 1986
Four cases of unilateral traumatic cerebral lesion with secondary third nerve palsy are reported.... more Four cases of unilateral traumatic cerebral lesion with secondary third nerve palsy are reported. These four cases were observed over the course of one year and represent 5% of all unilateral traumatic cerebral lesion observed in our department during that period. The clinical situation presumptive of tentorial herniation included: partial (2 patients) or total (2 patients) secondary third nerve palsy, homolateral to the cerebral lesion; noncomatose state with initial Glasgow verbal score of 3 or greater; slight or no contralateral deficit. The anatomic lesions are unilateral and included 2 cases of temporal hematoma, one case of hemispheric swelling with acute subdural hematoma, and one case of general brain edema with temporal hematoma; In all 4 cases the clinical course was favorable with medical treatment alone. Based on the clinical information (non comatose state) and CT-scans (basal cisterns present or slight compressed in 3 of 4 cases), the authors believe that there was no ...
Thrombosis Research, 1986
Journal of Neurology, Neurosurgery & Psychiatry, 1997
Objectives-To assess by electrophysiology the eVect of tibial selective neurotomy on muscle imbal... more Objectives-To assess by electrophysiology the eVect of tibial selective neurotomy on muscle imbalance of the spastic ankle. Method-The amplitudes of the H reflexes, M responses (muscle contractions recorded after stimulation of the tibial nerve), and Hmax:Mmax ratio were recorded in 12 patients with chronic lower limb spasticity, before and one month after tibial selective neurotomy. Recordings were done on medial and lateral gastrocnemius and soleus muscles. Clinical evaluation was done with both global (Held's score) and analytical tests (step measurements, gait velocity, and ankle angulation during active and passive movements). Results-After neurotomy, gait improved in all patients. Held 's score of spasticity was better in all patients. Active dorsiflexion of the ankle was unchanged in three patients, but the others improved by 5°to 12°. Hmax, Mmax, and Hmax:Mmax ratios were lower. The Hmax on the gastrocnemius muscle, clinical strength, Mmax of all the muscles, and Hmax:Mmax ratio for the soleus and lateral gastrocnemius muscle were significantly lower after surgery. Conclusion-There was an improvement of clinical and electrophysiological spastic indices after selective tibial neurotomy. Neurotomy acted not only on motor neurons by decreasing strength, but also the reflex enlargement by decreasing sensory aVerents.
Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression, 1987
Presse médicale (Paris, France : 1983), Jan 20, 1986
Presse médicale (Paris, France : 1983), Jan 27, 1987
The surgical treatment of cerebral abscesses has changed over recent years and consists, in most ... more The surgical treatment of cerebral abscesses has changed over recent years and consists, in most cases, of aspiration based on the data supplied by computerized tomography. The purpose of aspiration is threefold: to avoid a major surgical operation, to empty the abscess and thereby reduce its size, and to identify the responsible germ(s). A retrospective study of 35 cases shows that abscess of the brain remains a serious disease that jeopardizes the patient's vital and functional prognosis. Despite improvements in sample collection and isolation techniques, no microorganism is found in 30% of the cases. Therapeutic success therefore is dependent upon the effectiveness of emergency chemotherapy using combinations of two or three antibiotics. Monitoring with computerized tomography avoids unnecessarily prolonged treatments.
Journal of Neuroradiology, 1989
Revue Neurologique, 2005
L. VERCUEIL et coll. Éditorial Stimulation Pallidale dans la dystonie généralisée primaire L. Ver... more L. VERCUEIL et coll. Éditorial Stimulation Pallidale dans la dystonie généralisée primaire L. Vercueil, M. Vidailhet et le Groupe SPIDY* (Stimulation Pallidale Interne dans la dystonie)
Nature and Science of Sleep, 2013
Patients with Parkinson's disease frequently complain of sleep disturbances and loss of muscle at... more Patients with Parkinson's disease frequently complain of sleep disturbances and loss of muscle atonia during rapid-eye-movement (REM) sleep is not rare. The orexin-A (hypocretin-1) hypothalamic system plays a central role in controlling REM sleep. Loss of orexin neurons results in narcolepsy-cataplexy, a condition characterized by diurnal sleepiness and REM sleep without atonia. Alterations in the orexin-A system have been also documented in Parkinson's disease, but whether these alterations have clinical consequences remains unknown. Methods: Here, we measured orexin-A levels in ventricular cerebrospinal fluid from eight patients with Parkinson's disease (four males and four females) who underwent ventriculography during deep brain-stimulation surgery and performed full-night polysomnography before surgery. Results: Our results showed a positive correlation between orexin-A levels and REM sleep without muscle atonia. Conclusion: Our results suggest that high levels of orexin-A in Parkinson's disease may be associated with loss of REM muscle atonia.
European Journal of Pain, 2006
Clinical Neurophysiology, 2010
To assess the modulation of acute provoked pain by repetitive transcranial magnetic stimulation (... more To assess the modulation of acute provoked pain by repetitive transcranial magnetic stimulation (rTMS) of the motor cortex in patients with chronic neuropathic pain. In 32 patients with chronic neuropathic pain affecting one upper limb, laser-evoked potentials (LEPs) (N2 and P2 components) were recorded in response to laser stimulation of the painful or painless hand, before and after active or sham rTMS applied at 10Hz over the motor cortex corresponding to the painful hand. Laser-induced pain was scored on a visual analogue scale. Both active and sham rTMS reduced N2-P2 amplitude of the LEPs in response to painful or painless hand stimulation, likely due to the decline of attention during the sessions. However, active rTMS, but not sham rTMS, specifically reduced N2 amplitude and N2/P2 amplitude ratio of the painful hand LEPs. Painful hand LEP attenuation correlated with the magnitude of pain relief produced by active rTMS. Motor cortex rTMS delivered at high frequency (10Hz) was able to reduce LEP amplitude in parallel with laser-induced pain scores in patients with chronic neuropathic pain. The preferential change in the N2 component suggested a modulation of the sensori-discriminative aspect of laser-induced pain. Previous studies have shown that rTMS delivered to various cortical targets by different protocols could modulate experimental pain, primarily in healthy subjects. The present results demonstrate the ability of motor cortex rTMS to interfere with the processing of acute provoked pain, even if there is an underlying chronic neuropathic pain.
Neuromodulation: Technology at the Neural Interface, 2020
Background: Occipital nerve stimulation (ONS) is shown to be effective in treating various forms ... more Background: Occipital nerve stimulation (ONS) is shown to be effective in treating various forms of headache. Most studies describe the treatment of occipital neuralgia (ON), but in many patients, the clinical description could also correspond to cervicogenic headache (CGH) or occipital migraine (OM). These different entities (ON, CGH, and OM) may be grouped together under the term occipital headaches. Objective: To assess the efficacy of ONS to treat occipital headaches in a large series of patients with a long-term follow-up. Materials and Methods: We performed a retrospective review of data on 60 patients with intractable occipital headaches treated with occipital nerve stimulation (ONS), who were referred to our center between October 2008 and October 2014. Details of pain evaluation, location, duration, cause and previous treatment were analyzed. Evaluations included the visual analog scale (VAS), the number of headache days per month (NHD), and the Medication Quantification Scale (MQS). Trials with transcutaneous electrical nerve stimulation (TENS-ONS) were performed and served as a guide for surgery indication (see Patients and Method section). Results: After one year of ONS, mean VAS had decreased from 8.4/10 to 2.8/10 (72.2% reduction [p < 0.001]), and 76% of patients had at least a 50% decrease in mean VAS score. The mean MQS score decreased from 18 to 8.8, corresponding to a reduction of pain medication by an average of 50%. Adverse events concerned 12 patients (20%). Six patients presented with electrode displacement or fracture (10%) and six patients presented with cases of infection (10%) associated with the pulse generator. Conclusions: The results of this large series confirm that ONS is an effective treatment option for patients with intractable occipital headaches, but the frequency of complications remains quite high and must be taken into account in the surgical decision.
Journal of Pain & Relief, 2016
Introduction: Spinal cord stimulation is now a treatment of pain in refractory failed back surger... more Introduction: Spinal cord stimulation is now a treatment of pain in refractory failed back surgery syndrome. The effect on radiculalgias is quite good but often unsatisfying to treat completely low back pain. Subcutaneous peripheral nerve stimulation is now one of the possibility to rescue chronic low back pain. The aim of this prospective study conducted in our center (Nantes, France) is to evaluate the benefit of the subcutaneous peripheral nerve stimulation on chronic low back pain. Method: 34 patients (aged 44-65, mean value 54.3) with chronic bilateral low back pain were evaluated with VAS Score, Medication quantification Scale (MQS), the patient satisfaction, and walking distance before and after stimulation. Stimulation was proposed after failure of multidisciplinary management of the patient with algologist, psychologist and rehabilitation. Electrode stimulation was implanted under local or general anesthesia and a test of 7 days was performed at home. The battery was implanted only if VAS score decreased than more 50%. Mean Follow up was 6 months (range 42 to 3 months). Result: All of 34 patients were implanted with good results: VAS score decreased from 7.5 in preoperative conditions to 2.3 in postop conditions (p ≤ 0.001). 63% of patients estimated than they were very satisfy of the surgery and they could propose that to patients. The MQS decreased from 34 in preoperative to 26 two months after the surgery and to 17 6 months after surgery. Walking distance increase after the surgery (800 meters before surgery and 1700 meters after surgery). We have 1 infection and one migration of electrodes Conclusion: this series shows that subcutaneous stimulation can be benefit to treat refractory low back pain. This surgery was well tolerated, safe.
Reviews on recent clinical trials, 2018
Apathy, commonly defined as the loss of motivation, is a symptom frequently encountered in Alzhei... more Apathy, commonly defined as the loss of motivation, is a symptom frequently encountered in Alzheimer's Disease (AD). The treatment of apathy remains challenging in the absence of any truly effective medications. Transcranial Magnetic Stimulation (rTMS) or Transcranial Direct Current Stimulation (tDCS) can improve cognitive disorders, but do not appear to improve apathy. Isolated cognitive training also appears to have no effect on apathy. We propose to test the efficacy of a new procedure for the treatment of apathy in AD patients consisting of a combination of tDCS and cognitive training, based on the latest guidelines for the design of therapeutic trials in this field. This article primarily describes the design of a monocentre, randomized, doubleblind trial to be conducted in France to evaluate the effect of the combination of tDCS and cognitive training on apathy compared to a group treated exclusively by cognitive training (sham tDCS). Twenty- four patients under the age of...
Neurophysiologie Clinique/Clinical Neurophysiology, 2016
Presse médicale (Paris, France : 1983), Jan 27, 1997
Des techniques en fonction de la symtomatologie: Le traitement chirurgical de la maladie de Parki... more Des techniques en fonction de la symtomatologie: Le traitement chirurgical de la maladie de Parkinson a beaucoup evolue au cours de ces dernieres annees. Le tremblement de repos est actuellement tres bien controle par la stimulation chronique du thalamus. La pallidotomie ou la stimulation chronique du pallidum sont efficaces sur les dyskinesie dopa-induites. La stimulation chronique du noyau sous-thalamique ou les greffes intrastriatales de neurones dopaminergiques sont des nterventions encore au stade experimental. Elles s'averent d'ores et deja remarquablement efficaces sur l'akinesie. Uniquement en deuxieme intention: Toutes ces interventions ne sont a discuter que chez des patients bien suivis cliniquement et qui resistent ou echappent a un traitement medical bien conduit. La dopatherapie doit avoir ete suffisamment prolongee, a une dose d'au moins 1000 milligrammes par jour.
Multiple Sclerosis and Related Disorders
Neurophysiologie Clinique/Clinical Neurophysiology, 2016
A cote du traitement des mouvements anormaux, le traitement des douleurs chroniques represente un... more A cote du traitement des mouvements anormaux, le traitement des douleurs chroniques represente un chapitre important de la neurochirurgie fonctionnelle. Dans le domaine des douleurs dites par exces de nociception, dont la forme la plus typique est la douleur cancereuse, les interventions de section des voies de la douleur ont ete pratiquement remplacees par les traitements a base de morphine qui peuvent etre eventuellement administres par voie intrathecale. Le role de la neurochirurgie fonctionnelle s’est donc beaucoup restreint dans cette indication, d’autant plus que la plupart des « pompes intrathecales » sont placees par des medecins anesthesistes. Nous nous interesserons essentiellement au traitement des douleurs neuropathiques ou la neurochirurgie fonctionnelle est tres souvent sollicitee pour discuter de l’interet d’une technique de neuromodulation. Ces techniques que l’on denommait au debut de neurostimulation ont ete developpees il y a environ 40 ans, comme une application pratique de la theorie du « Gate control » de Wall et Melzack. L’idee etait que la stimulation electrique des fibres sensitives de gros diametre (fibres A-beta) pouvait inhiber la transmission du message douloureux qui emprunte les voies constituees par les fibres sensitives de petit diametre (fibres C). Les premieres applications ont ete de facon surprenante tres invasives puisqu’il s’agissait de stimuler le noyau ventro postero lateral (VPL) du thalamus, notamment pour le traitement des membres douloureux fantomes (G. Mazars, 1970). C’est aux environs de 1975 que s’est developpee la stimulation des cordons posterieurs de la moelle epiniere, appelee communement stimulation medullaire (SM). Contrairement a la stimulation du VPL, qui n’etait finalement pas tres efficace a moyen et long terme, la SM a eu rapidement un enorme succes. Elle s’etait, en effet, averee extremement efficace dans le traitement des sciatalgies neuropathiques rencontrees dans le cadre du « Failed Back Surgery Syndrome (FBSS) » actuellement denomme en francais par « echec de la chirurgie du bas du dos » par l’HAS (Haute Autorite de sante). L’intervention etait tres peu invasive lorsqu’elle etait realisee par voie percutanee, ce qui a indeniablement contribue a son succes. Certaines douleurs, comme celles qui etaient secondaires a un accident vasculaire cerebral, ne pouvaient cependant pas etre traitees par la SM. C’est en 1991 qu’un neurochirurgien japonais (Tsubokawa) a montre que la stimulation du cortex moteur pouvait ameliorer ce type de douleur. C’est ce principe qui a abouti au developpement de la stimulation magnetique transcrânienne (SMT) du cortex moteur pour le traitement des douleurs neuropathiques (1995). Le developpement le plus recent concerne la stimulation du nerf occipital, dont l’efficacite dans le traitement de la migraine suggere bien que l’action benefique de ces techniques est plus une modulation de circuits a priori « dysfonctionnels » qu’une neurostimulation de circuits deficients.
Douleurs : Evaluation - Diagnostic - Traitement, 2012
Actes du congrès de la SFETD, Lille, 21-24 novembre 2012 moyennée) et 35 % des patients se sont e... more Actes du congrès de la SFETD, Lille, 21-24 novembre 2012 moyennée) et 35 % des patients se sont estimés améliorer, et ce, quel que soit le bras. Conclusion.-Le bloc anesthésique pudendal reste indispensable au diagnostic. Les corticoïdes n'apportent pas de gain thérapeutique. Le traitement de référence reste la chirurgie.
Neuro-Chirurgie, 1986
Four cases of unilateral traumatic cerebral lesion with secondary third nerve palsy are reported.... more Four cases of unilateral traumatic cerebral lesion with secondary third nerve palsy are reported. These four cases were observed over the course of one year and represent 5% of all unilateral traumatic cerebral lesion observed in our department during that period. The clinical situation presumptive of tentorial herniation included: partial (2 patients) or total (2 patients) secondary third nerve palsy, homolateral to the cerebral lesion; noncomatose state with initial Glasgow verbal score of 3 or greater; slight or no contralateral deficit. The anatomic lesions are unilateral and included 2 cases of temporal hematoma, one case of hemispheric swelling with acute subdural hematoma, and one case of general brain edema with temporal hematoma; In all 4 cases the clinical course was favorable with medical treatment alone. Based on the clinical information (non comatose state) and CT-scans (basal cisterns present or slight compressed in 3 of 4 cases), the authors believe that there was no ...
Thrombosis Research, 1986
Journal of Neurology, Neurosurgery & Psychiatry, 1997
Objectives-To assess by electrophysiology the eVect of tibial selective neurotomy on muscle imbal... more Objectives-To assess by electrophysiology the eVect of tibial selective neurotomy on muscle imbalance of the spastic ankle. Method-The amplitudes of the H reflexes, M responses (muscle contractions recorded after stimulation of the tibial nerve), and Hmax:Mmax ratio were recorded in 12 patients with chronic lower limb spasticity, before and one month after tibial selective neurotomy. Recordings were done on medial and lateral gastrocnemius and soleus muscles. Clinical evaluation was done with both global (Held's score) and analytical tests (step measurements, gait velocity, and ankle angulation during active and passive movements). Results-After neurotomy, gait improved in all patients. Held 's score of spasticity was better in all patients. Active dorsiflexion of the ankle was unchanged in three patients, but the others improved by 5°to 12°. Hmax, Mmax, and Hmax:Mmax ratios were lower. The Hmax on the gastrocnemius muscle, clinical strength, Mmax of all the muscles, and Hmax:Mmax ratio for the soleus and lateral gastrocnemius muscle were significantly lower after surgery. Conclusion-There was an improvement of clinical and electrophysiological spastic indices after selective tibial neurotomy. Neurotomy acted not only on motor neurons by decreasing strength, but also the reflex enlargement by decreasing sensory aVerents.
Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression, 1987
Presse médicale (Paris, France : 1983), Jan 20, 1986
Presse médicale (Paris, France : 1983), Jan 27, 1987
The surgical treatment of cerebral abscesses has changed over recent years and consists, in most ... more The surgical treatment of cerebral abscesses has changed over recent years and consists, in most cases, of aspiration based on the data supplied by computerized tomography. The purpose of aspiration is threefold: to avoid a major surgical operation, to empty the abscess and thereby reduce its size, and to identify the responsible germ(s). A retrospective study of 35 cases shows that abscess of the brain remains a serious disease that jeopardizes the patient's vital and functional prognosis. Despite improvements in sample collection and isolation techniques, no microorganism is found in 30% of the cases. Therapeutic success therefore is dependent upon the effectiveness of emergency chemotherapy using combinations of two or three antibiotics. Monitoring with computerized tomography avoids unnecessarily prolonged treatments.
Journal of Neuroradiology, 1989
Revue Neurologique, 2005
L. VERCUEIL et coll. Éditorial Stimulation Pallidale dans la dystonie généralisée primaire L. Ver... more L. VERCUEIL et coll. Éditorial Stimulation Pallidale dans la dystonie généralisée primaire L. Vercueil, M. Vidailhet et le Groupe SPIDY* (Stimulation Pallidale Interne dans la dystonie)
Nature and Science of Sleep, 2013
Patients with Parkinson's disease frequently complain of sleep disturbances and loss of muscle at... more Patients with Parkinson's disease frequently complain of sleep disturbances and loss of muscle atonia during rapid-eye-movement (REM) sleep is not rare. The orexin-A (hypocretin-1) hypothalamic system plays a central role in controlling REM sleep. Loss of orexin neurons results in narcolepsy-cataplexy, a condition characterized by diurnal sleepiness and REM sleep without atonia. Alterations in the orexin-A system have been also documented in Parkinson's disease, but whether these alterations have clinical consequences remains unknown. Methods: Here, we measured orexin-A levels in ventricular cerebrospinal fluid from eight patients with Parkinson's disease (four males and four females) who underwent ventriculography during deep brain-stimulation surgery and performed full-night polysomnography before surgery. Results: Our results showed a positive correlation between orexin-A levels and REM sleep without muscle atonia. Conclusion: Our results suggest that high levels of orexin-A in Parkinson's disease may be associated with loss of REM muscle atonia.
European Journal of Pain, 2006
Clinical Neurophysiology, 2010
To assess the modulation of acute provoked pain by repetitive transcranial magnetic stimulation (... more To assess the modulation of acute provoked pain by repetitive transcranial magnetic stimulation (rTMS) of the motor cortex in patients with chronic neuropathic pain. In 32 patients with chronic neuropathic pain affecting one upper limb, laser-evoked potentials (LEPs) (N2 and P2 components) were recorded in response to laser stimulation of the painful or painless hand, before and after active or sham rTMS applied at 10Hz over the motor cortex corresponding to the painful hand. Laser-induced pain was scored on a visual analogue scale. Both active and sham rTMS reduced N2-P2 amplitude of the LEPs in response to painful or painless hand stimulation, likely due to the decline of attention during the sessions. However, active rTMS, but not sham rTMS, specifically reduced N2 amplitude and N2/P2 amplitude ratio of the painful hand LEPs. Painful hand LEP attenuation correlated with the magnitude of pain relief produced by active rTMS. Motor cortex rTMS delivered at high frequency (10Hz) was able to reduce LEP amplitude in parallel with laser-induced pain scores in patients with chronic neuropathic pain. The preferential change in the N2 component suggested a modulation of the sensori-discriminative aspect of laser-induced pain. Previous studies have shown that rTMS delivered to various cortical targets by different protocols could modulate experimental pain, primarily in healthy subjects. The present results demonstrate the ability of motor cortex rTMS to interfere with the processing of acute provoked pain, even if there is an underlying chronic neuropathic pain.
Neuromodulation: Technology at the Neural Interface, 2020
Background: Occipital nerve stimulation (ONS) is shown to be effective in treating various forms ... more Background: Occipital nerve stimulation (ONS) is shown to be effective in treating various forms of headache. Most studies describe the treatment of occipital neuralgia (ON), but in many patients, the clinical description could also correspond to cervicogenic headache (CGH) or occipital migraine (OM). These different entities (ON, CGH, and OM) may be grouped together under the term occipital headaches. Objective: To assess the efficacy of ONS to treat occipital headaches in a large series of patients with a long-term follow-up. Materials and Methods: We performed a retrospective review of data on 60 patients with intractable occipital headaches treated with occipital nerve stimulation (ONS), who were referred to our center between October 2008 and October 2014. Details of pain evaluation, location, duration, cause and previous treatment were analyzed. Evaluations included the visual analog scale (VAS), the number of headache days per month (NHD), and the Medication Quantification Scale (MQS). Trials with transcutaneous electrical nerve stimulation (TENS-ONS) were performed and served as a guide for surgery indication (see Patients and Method section). Results: After one year of ONS, mean VAS had decreased from 8.4/10 to 2.8/10 (72.2% reduction [p < 0.001]), and 76% of patients had at least a 50% decrease in mean VAS score. The mean MQS score decreased from 18 to 8.8, corresponding to a reduction of pain medication by an average of 50%. Adverse events concerned 12 patients (20%). Six patients presented with electrode displacement or fracture (10%) and six patients presented with cases of infection (10%) associated with the pulse generator. Conclusions: The results of this large series confirm that ONS is an effective treatment option for patients with intractable occipital headaches, but the frequency of complications remains quite high and must be taken into account in the surgical decision.
Journal of Pain & Relief, 2016
Introduction: Spinal cord stimulation is now a treatment of pain in refractory failed back surger... more Introduction: Spinal cord stimulation is now a treatment of pain in refractory failed back surgery syndrome. The effect on radiculalgias is quite good but often unsatisfying to treat completely low back pain. Subcutaneous peripheral nerve stimulation is now one of the possibility to rescue chronic low back pain. The aim of this prospective study conducted in our center (Nantes, France) is to evaluate the benefit of the subcutaneous peripheral nerve stimulation on chronic low back pain. Method: 34 patients (aged 44-65, mean value 54.3) with chronic bilateral low back pain were evaluated with VAS Score, Medication quantification Scale (MQS), the patient satisfaction, and walking distance before and after stimulation. Stimulation was proposed after failure of multidisciplinary management of the patient with algologist, psychologist and rehabilitation. Electrode stimulation was implanted under local or general anesthesia and a test of 7 days was performed at home. The battery was implanted only if VAS score decreased than more 50%. Mean Follow up was 6 months (range 42 to 3 months). Result: All of 34 patients were implanted with good results: VAS score decreased from 7.5 in preoperative conditions to 2.3 in postop conditions (p ≤ 0.001). 63% of patients estimated than they were very satisfy of the surgery and they could propose that to patients. The MQS decreased from 34 in preoperative to 26 two months after the surgery and to 17 6 months after surgery. Walking distance increase after the surgery (800 meters before surgery and 1700 meters after surgery). We have 1 infection and one migration of electrodes Conclusion: this series shows that subcutaneous stimulation can be benefit to treat refractory low back pain. This surgery was well tolerated, safe.
Reviews on recent clinical trials, 2018
Apathy, commonly defined as the loss of motivation, is a symptom frequently encountered in Alzhei... more Apathy, commonly defined as the loss of motivation, is a symptom frequently encountered in Alzheimer's Disease (AD). The treatment of apathy remains challenging in the absence of any truly effective medications. Transcranial Magnetic Stimulation (rTMS) or Transcranial Direct Current Stimulation (tDCS) can improve cognitive disorders, but do not appear to improve apathy. Isolated cognitive training also appears to have no effect on apathy. We propose to test the efficacy of a new procedure for the treatment of apathy in AD patients consisting of a combination of tDCS and cognitive training, based on the latest guidelines for the design of therapeutic trials in this field. This article primarily describes the design of a monocentre, randomized, doubleblind trial to be conducted in France to evaluate the effect of the combination of tDCS and cognitive training on apathy compared to a group treated exclusively by cognitive training (sham tDCS). Twenty- four patients under the age of...
Neurophysiologie Clinique/Clinical Neurophysiology, 2016
Presse médicale (Paris, France : 1983), Jan 27, 1997
Des techniques en fonction de la symtomatologie: Le traitement chirurgical de la maladie de Parki... more Des techniques en fonction de la symtomatologie: Le traitement chirurgical de la maladie de Parkinson a beaucoup evolue au cours de ces dernieres annees. Le tremblement de repos est actuellement tres bien controle par la stimulation chronique du thalamus. La pallidotomie ou la stimulation chronique du pallidum sont efficaces sur les dyskinesie dopa-induites. La stimulation chronique du noyau sous-thalamique ou les greffes intrastriatales de neurones dopaminergiques sont des nterventions encore au stade experimental. Elles s'averent d'ores et deja remarquablement efficaces sur l'akinesie. Uniquement en deuxieme intention: Toutes ces interventions ne sont a discuter que chez des patients bien suivis cliniquement et qui resistent ou echappent a un traitement medical bien conduit. La dopatherapie doit avoir ete suffisamment prolongee, a une dose d'au moins 1000 milligrammes par jour.