Mathieu Sévin - Academia.edu (original) (raw)

Papers by Mathieu Sévin

Journal of Internal Medicine, 2019

All authors contributed substantially to the study and approved the final version of the article.... more All authors contributed substantially to the study and approved the final version of the article. CV and NJ take responsibility for the paper as a whole.

Pédagogie médicale, 2008

Recherche et Perspectives Etude descriptive des pratiques d'apprentissage d'étudiants en quatrièm... more Recherche et Perspectives Etude descriptive des pratiques d'apprentissage d'étudiants en quatrième année de médecine dans une faculté française et de leurs performances à résoudre un problème Descriptive study of learning practices and their problem-solving performances in fourth year medical students Résumé Contexte : Les activités d'enseignement et d'apprentissage en petits groupes deviennent difficiles à maintenir en raison de l'augmentation du numerus clausus imposée par la législation française. Avant d'envisager d'autres alternatives pédagogiques compatibles avec les principes d'une pédagogie active et dans le contexte d'une épreuve sommative et normative classante nationale, nous avons réalisé une étude prospective chez des étudiants en 4 e année de médecine pour décrire leurs approches d'apprentissage (profondeur et surface), leurs stratégies d'apprentissage (SA) et de résolution de problème (SRP) et leurs performances à résoudre un problème simulés par écrit. Matériel et méthodes : Pour un thème donné (« épilepsie ») du programme de l'épreuve classante nationale, l'approche d'apprentissage a été évaluée par le questionnaire de Biggs. Les SA et SRP ont été évaluées par deux questionnaires construits d'après les récentes données de la littérature. Les performances à résoudre un problème ont été évaluées au cours d'une séance pendant laquelle les étudiants devaient résoudre deux problèmes cliniques d'épilepsie sous forme de vignettes-papier. Résultats : L'approche d'apprentissage en profondeur prédomine. Les SA métacognitives sont déjà développées en 4 e année. Le répertoire des SRP n'est pas utilisé de façon éclectique. Une corrélation entre l'approche en profondeur, les stratégies d'apprentissage de niveau 3 (stratégies de catégorisation des informations) et les performances à résoudre un des deux problèmes cliniques a été observée. Conclusion : La prédominance d'une approche d'apprentissage en profondeur, le développement de SA de type métacognitif et le constat de certaines limites dans l'utilisation de SRP nous font envisager la généralisation de l'apprentissage autonome à partir de référentiels didactiques, du tutorat et de séances d'entraînement au raisonnement médical. Mots clés Stratégies de résolution de problème ; stratégies d'apprentissage ; approche d'apprentissage ; activités en petits groupes.

Panminerva medica, 2013

Over the last 15 years, advances in acute ischemic stroke (AIS) management have led to a signific... more Over the last 15 years, advances in acute ischemic stroke (AIS) management have led to a significant reduction in the morbidity and mortality related to this serious disease. This has resulted from progress in imaging technology, increased access to imaging procedures, enhanced coordination in stroke care from emergency departments to rehabilitation centers, development of organized inpatient stroke units, and to the widespread use of acute thrombolysis. Once the diagnosis of AIS is confirmed by neuroimaging, the etiological work up is conducted in parallel with therapeutic measures by stroke units. The intravenous administration of recombinant tissue plasminogen activator (rt-PA) remains the most beneficial intervention in emergency stroke management, but it must be administered within 4.5 hours following the onset of symptoms and only in eligible patients. Recently, several procedures for increasing the efficacy of arterial recanalization have emerged, including intra-arterial adm...

Annals of Physical and Rehabilitation Medicine, 2014

Accident vasculaire cérébral / Annals of Physical and Rehabilitation Medicine 57S (2014) e29-e34 ... more Accident vasculaire cérébral / Annals of Physical and Rehabilitation Medicine 57S (2014) e29-e34 e31 répartis en 3 groupes, selon leur autonomie de marche évaluée par la Functionnal Ambulation Classification (FAC/5) : G1 (FAC 0 ; 34 patients non marchants), G2 (FAC 1 ou 2 ; 30 patients marchants avec une aide physique) et G3 (FAC ≥ 3/5 ; 24 patients marchants sans aide physique). Résultats.-Il existait des différences significatives sur la DE totale (Kcal) entre G1 (653,4 ± 179,2)/G3 (732,7 ± 162,7) et G2 (625,6 ± 141,7)/G3 (732,7 ± 162,7), sur la DE modérée (Kcal) entre G1 (70,1 ± 108,5)/G3(129,9 ± 152,0) et G2 (81,8 ± 98,1)/G3 (129,9 ± 152,0) et sur le temps d'activité physique (minutes) entre G1 (17,1 ± 28,6)/G3 (31,7 ± 37,1). En revanche, aucune différence n'est apparue entre G1 et G2. Discussion.-Nous pensions trouver une DE croissante en fonction de l'autonomie de marche, or cette hypothèse est rejetée vu le niveau similaire entre G1 et G2. Les patients marchants avec aide devraient donc être plus sollicités dans un double objectif : améliorer leur qualité de marche et augmenter leur DE.

EMC - Neurologia, 2010

L'infarto cerebrale è un'urgenza terapeutica come l'infarto miocardico. La diagnosi si sospetta c... more L'infarto cerebrale è un'urgenza terapeutica come l'infarto miocardico. La diagnosi si sospetta clinicamente davanti a un improvviso deficit neurologico focale ed è confermata dalla diagnostica per immagini, in primo luogo dalla risonanza magnetica (RM). L'obiettivo principale è di ripristinare il più rapidamente possibile una corretta perfusione nel territorio in sofferenza ischemica, per preservare il massimo di neuroni. Sono stati compiuti notevoli progressi negli ultimi anni, grazie alla ricanalizzazione chimica (trombolisi sistemica somministrata entro 4 ore e 30 minuti), associata o meno alla trombectomia meccanica. Per permettere al massimo numero di pazienti di beneficiare di questo approccio, la gestione deve inserirsi in una filiera organizzata e coordinata. Questa filiera comprende una fase preospedaliera (identificazione di sintomi, allarme e trasporto del paziente) e una fase ospedaliera per la diagnosi in urgenza e l'attuazione del trattamento. Le unità neurovascolari sono le strutture dedicate alla gestione in urgenza degli accidenti vascolari cerebrali (AVC) e assicurano il ruolo di coordinamento della filiera. Esse possono anche assicurare un ruolo di consulenza a distanza attraverso la telemedicina. Oltre alle tecniche di riperfusione, l'attuazione di misure terapeutiche non specifiche ma ben identificate permette di ridurre la morbimortalità legata agli infarti: mantenimento delle funzioni respiratoria, cardiaca ed emodinamica e dell'equilibrio idroelettrolitico e glicemico e prevenzione, screening e, se necessario, trattamento delle complicanze neurologiche o generali (edema cerebrale, trasformazione emorragica, recidiva precoce, epilessia, infezioni, malattia tromboembolica venosa, ecc.). Nonostante numerosi studi terapeutici, la neuroprotezione cerebrale è ancora in fase di ricerca. L'informazione del grande pubblico sul riconoscimento dei segnali di allarme e sulla necessità di far scattare in urgenza un allarme, così come l'adattamento del sistema di cure ai tempi pre-e intraospedalieri, sono gli obiettivi da raggiungere per migliorare ulteriormente la gestione degli infarti cerebrali.

Journal of Medical Genetics, 2009

Male carriers of the FMR1 premutation are at risk of developing the fragile X-associated tremor/a... more Male carriers of the FMR1 premutation are at risk of developing the fragile X-associated tremor/ataxia syndrome (FXTAS), a newly recognised and largely under-diagnosed late onset neurodegenerative disorder. Patients affected with FXTAS primarily present with cerebellar ataxia and intention tremor. Cognitive decline has also been associated with the premutation, but the lack of data on its penetrance is a growing concern for clinicians who provide genetic counselling. The Mattis Dementia Rating Scale (MDRS) was administered in a double blind fashion to 74 men aged 50 years or more recruited from fragile X families (35 premutation carriers and 39 intrafamilial controls) regardless of their clinical manifestation. Based on previous publications, marked cognitive impairment was defined by a score &amp;amp;amp;lt;or=123 on the MDRS. Both logistic and survival models confirmed that in addition to age and education level, premutation size plays a significant (p&amp;amp;amp;lt;0.01 and p&amp;amp;amp;lt;0.03 for logistic and survival model, respectively) role in cognitive impairment. The estimated penetrance of marked cognitive impairment in our sample (adjusted for the mean age 63.4 years and mean education level 9.7 years) for midsize/large (70-200 CGG) and small (55-69 CGG) premutation alleles was 33.3% (relative risk (RR) 6.5; p = 0.01) and 5.9% (RR 1.15; p = 0.9) respectively. Penetrance in the control group was 5.1%. Male carriers of midsize to large premutation alleles had a sixfold increased risk of developing cognitive decline and the risk increases with allele size. In addition, it was observed that cognitive impairment may precede motor symptoms. These data provide guidance for genetic counselling although larger samples are required to refine these estimates.

Brain, 2006

Niemann-Pick disease type C (NPC) is a fatal neurovisceral lipid storage disease of autosomal inh... more Niemann-Pick disease type C (NPC) is a fatal neurovisceral lipid storage disease of autosomal inheritance resulting from mutations in either the NPC1 (95% of families) or NPC2 gene. The encoded proteins appear to be involved in lysosomal/late endosomal transport of cholesterol, glycolipids and other molecules but their exact function is still unknown. The clinical spectrum of the disease ranges from a neonatal rapidly fatal disorder to an adult-onset chronic neurodegenerative disease. Based upon a comprehensive study of 13 unrelated adult patients diagnosed in France over the past 20 years as well as the analysis of the 55 other cases published since 1969, we have attempted to delineate the major clinical, radiological, biochemical and genotypic characteristics of adult NPC. Overall, mean age at onset (6SD) of neuropsychiatric symptoms was 25 6 9.7 years. The diagnosis of NPC was established after a mean delay of 6.2 6 6.4 years and the mean age at death (calculated from 20 cases) was 38 6 10.2 years. Major clinical features included cerebellar ataxia (76%), vertical supranuclear ophthalmoplegia (VSO, 75%), dysarthria, (63%), cognitive troubles (61%), movement disorders (58%), splenomegaly (54%), psychiatric disorders (45%) and dysphagia (37%). Less frequent signs were epilepsy and cataplexy. During the course of the disease, clinical features could be subdivided into (i) visceral signs (hepatomegaly or splenomegaly), (ii) cortical signs (psychiatric cognitive disorders and epilepsy); and (iii) deep brain signs (VSO, ataxia, movement disorders, dysarthria, dysphagia, cataplexy) which exhibited different evolution patterns. Asymptomatic and non-evolutive visceral signs were often noticed since early childhood (38.5% of our patients), followed by mild cortical signs in childhood (learning difficulties) and early adulthood (62% of cases among which 38% were psychiatric disorders). Deep brain signs were observed in 96% of patients and were usually responsible for death. In general, there was a good correlation between clinical signs and the localization of brain atrophy on MRI. The 'variant' biochemical phenotype characterized by mild abnormalities of the cellular trafficking of endocytosed cholesterol was over-represented in the adult form of NPC and seemed associated with less frequent splenomegaly in childhood and lesser psychiatric signs. Involvement of the NPC1 gene was shown in 33 families and of the NPC2 gene in one. Improving the knowledge of the disease among psychiatrists and neurologists appears essential since emerging treatments should be more efficient at the visceral or cognitive/psychiatric stages of the disease, before the occurrence of widespread deep brain neurological lesions.

American Journal of Neuroradiology, 2011

BACKGROUND AND PURPOSE: Patients harboring nongiant cerebral aneurysms may rarely present with an... more BACKGROUND AND PURPOSE: Patients harboring nongiant cerebral aneurysms may rarely present with an ischemic infarct distal to the aneurysm. The aim of this case series was to report clinical and radiologic characteristics of these patients, their management, and outcome. MATERIALS AND METHODS: We undertook a single-center retrospective analysis of consecutive patients admitted during an 8-year period with an acute ischemic stroke revealing an unruptured nongiant (Ͻ25 mm) sacciform intracranial aneurysm. Clinical, radiologic, therapeutic, and follow-up data were analyzed. RESULTS: Nine patients were included. The mean size of aneurysms was 9.6 Ϯ 6 mm, and 5 were partially or totally thrombosed. Two patients had a fatal SAH within 3 days after stroke-symptom onset, whereas asymptomatic meningeal bleeding was diagnosed or suspected in 2 others. Most of the patients with unthrombosed aneurysms were successfully treated by endovascular coiling in the acute phase. Thrombosed aneurysms were usually treated with antithrombotics, and most recanalized secondarily, requiring endovascular treatment or surgical obliteration. No recurrence of an ischemic event or SAH was observed during the 31 Ϯ 12 months of follow-up (from 4 to 53 months). CONCLUSIONS: In this single-center series, the frequency of early SAH in patients with ischemic stroke distal to an unruptured intracranial aneurysm was high. Acute management should be undertaken with care regarding antithrombotic use, and early endovascular coiling should be considered. ABBREVIATIONS: MCA ϭ middle cerebral artery; mRS ϭ modified Rankin Scale; NIHSS ϭ National Institutes of Health Stroke Scale; PCA ϭ posterior cerebral artery; PICA ϭ posterior inferior cerebellar artery; SAH ϭ subarachnoid hemorrhage

La Revue de Médecine Interne, 2012