Background: Cortical electrical stimulation (CES) may produce different motor responses according to the brain area stimulated. In this study, we describe a new motor response characterized by finger movements such as a person playing piano, which we named the Piano Player Hand (PPH) sign. Methods: We retrospectively reviewed the CES results of 252 patients with drug-resistant epilepsy who underwent SEEG between January 2005 and December 2019 at the Grenoble-Alpes University Hospital. The patients’ characteristics, SEEG findings and CES parameters were extracted to find common clinical and anatomical features. Results: The PPH sign was identified 20 times from 12 patients, with stimulation of either the supplementary motor area (SMA), anterior cingulate gyrus (ACG), pre-SMA, middle frontal gyrus and anterior insula. It was obtained with high frequency stimulation, with intensity ranging from 0,7 to 3mA and mostly contralateral to the stimulation side (19/20). It was part of the ictal semiology of five patients. An afterdischarge was observed in five of the relevant CES. Conclusions: The PPH sign is a novel clinical sign, obtained mainly, but not exclusively, with CES of a small vicinity encompassing the SMA, pre-SMA and ACG. The PPH sign, when occurring ictally, may point to the premotor mesial frontal surface of the brain.

The vagus nerve (VN) is a link between the brain and the gut. The VN is a mixed nerve with anti-inflammatory properties through the activation of the hypothalamic-pituitary-adrenal axis by its afferents and by activating the cholinergic anti-inflammatory pathway through its efferents. We have previously shown that VN stimulation (VNS) improves colitis in rats and that the vagal tone is blunted in Crohn's disease (CD) patients. We thus performed a pilot study of chronic VNS in patients with active CD. Seven patients under VNS were followed up for 6 months with a primary endpoint to induce clinical remission and a secondary endpoint to induce biological (CRP and/or fecal calprotectin) and endoscopic remission and to restore vagal tone (heart rate variability). Vagus nerve stimulation was feasible and well-tolerated in all patients. Among the seven patients, two were removed from the study at 3 months for clinical worsening and five evolved toward clinical, biological, and endoscopic remission with a restored vagal tone. These results provide the first evidence that VNS is feasible and appears as an effective tool in the treatment of active CD.

There is a bidirectional communication between the brain and the gut through the autonomic nervous system (ANS), represented by the sympathetic and parasympathetic nervous systems. The vagus nerve (VN) is a major component of the ANS which plays a key role in the neuroendocrine-immune axis to maintain homeostasis through its afferents (via the activation of the hypothalamic pituitary adrenal axis) and efferents (via the cholinergic anti-inflammatory pathway; CAP). VN stimulation (VNS) is used for the treatment of drug-resistant epilepsy and depression in humans. We have shown for the first time in rats that chronic low frequency (5Hz) VNS, supposed to activate vagal efferents, has an anti-inflammatory effect in a model of TNBS-colitis, classically used as a model of Crohn’s disease (CD). Consequently, in a translational approach, VNS would be of interest in the treatment of moderate to severe CD. Anti-TNF therapy is presently the gold standard in the treatment of CD but VNS, based on its anti-TNF effect through the CAP, could be an alternative. We are performing a pilot study on VNS in patients with moderate to severe CD. We have implanted 8 patients and presently 6 patients are in remission. Vagal tone, measured by heart rate variability, is improved in most of the patients and we have previously shown that there is an inverse association between vagal tone and TNF-alpha level in CD patients. VNS could also be of interest in other TNF-mediated diseases, such as rheumatoid arthritis and psoriasis, as well as in irritable bowel syndrome.

Radiotherapy and chemotherapy may induce neurological toxicities with different appearances on CT and MRI scans. While optimized radiotherapy techniques have reduced some complications, new unwanted effects have occurred on account of therapeutic protocols involving the simultaneous use of radiotherapy and chemotherapy. Advances in radio-surgery, innovative anti-angiogenic therapies, as well as prolonged patient survival have led to the emergence of new deleterious side effects. In this report, we describe the early, semi-delayed, and late encephalic complications, while specifying how to identify the morphological lesions depending on the therapeutic protocol.

Objective. - The purpose of this study was to evaluate retrospectively whether cerebral blood volume measurement based on pretreatment perfusion MRI is a prognostic biomarker for survival in patients with oligodendroglioma or mixed oligoastrocytoma.Patients and methods. - Between 1998 and 2004, 54 patients (23 females and 31 males), aged 21-73 years, with oligodendroglioma (or mixed tumour) were examined prior to beginning treatment with dynamic susceptibility-weighted contrast (DSC) perfusion MRI during gadolinium first-pass. The relative cerebral blood volume (rCBV) was calculated by dividing the measurement within the tumour by the measurement of the normal-appearing contralateral region. Patients were classified in two groups, grade A and grade B, according to the Saint-Anne Hospital classification and followed-up clinically and by means of MRI until their death or for a minimum of 5 years. Patients were also classified in grade II and grade according to the World Health Organisation (WHO) classification, and were analysed with the same methods. Age, sex, treatment, tumour grade, contrast agent uptake, and rCBV were tested using survival curves with Kaplan-Meier's method, and their differences were analysed using the log-rank test.Results. - In this population, median survival was 3 years. A rCBV threshold value of 2.2 was validated as a prognostic factor, for survival in these patients with oligodendrogliomas. Age, sex, contrast uptake, and maximum rCBV were found to be prognostic factors in univariate analysis. Multivariate analysis revealed that tumour grade (grade A/grade B), rCBV, age, and sex were prognostic factors independent of the other factors. The tumour grade according to the WHO classification (II versus III-IV) was also detected as an independent prognostic factor.Conclusion. - Pretreatment rCBV measured by DSC perfusion MRI was found to be a prognostic factor for survival in patients with oligodendroglioma or mixed tumour, by using the Saint-Anne Hospital classification, which separate the IIB from the IIA. (C) 2010 Elsevier Masson SAS. All rights reserved.

In the stereo-electro-encephalography (SEEG) methodology developed by Talairach and Bancaud in Sainte-Anne Hospital in Paris, France, the objective of placing depth electrode recordings in presurgical evaluation is to study the spatial and temporal organization of a seizure. This defines for each patient the cortical onset zone, the propagation pattern of the seizure, and the possible involvement of eloquent areas of the cortex. This methodology requires a meticulous stereotactic surgical technique. We report here the SEEG methodology, surgical technique, and morbidity.

Identifier les mécanismes physiopathologiques des altérations des activations péritumorales en IRM fonctionnelle (IRMf). Vingt-et-un patients opérés d’une tumeur cérébrale primitive frontale ou pariétale, respectant le cortex sensorimoteur primaire (gliome de bas grade (n = 6), de haut grade (n = 6), méningiome (n = 9)) ont exécuté des tâches motrices simples en IRMf BOLD. Contrôle en IRM de la perfusion cérébrale et de la réponse BOLD à l’inhalation de carbogène. analyses BOLD par SPM5 et de la perfusion par ajustement gamma-dérivé (cartographies des débits (DSC) et volumes sanguins cérébraux (VSC), temps de transit moyen (TTM)). Les activations sensori-motrices primaires obtenues lors des mouvements controlatéraux étaient altérées dans l’hémisphère ipsitumoral. Ces altérations étaient liées à la proximité tumorale, à la nature tumorale et en particulier à l’existence d’une prise de contraste lésionnelle. Il n’y avait pas de relation avec la perfusion tumorale ou du cortex sensorimoteur sous-jacent à l’exception d’un allongement du TTM cortical en présence de méningiome. Ces altérations étaient également corrélées aux altérations des réponses BOLD corticales au carbogène. Ces résultats confirment l’existence d’altérations des activations péritumorales en IRMf pour des tumeurs qui prennent le contraste, l’intérêt du contrôle du signal BOLD au carbogène et suggèrent des mécanismes physiopathologiques différents selon la nature tumorale.

Temporal lobe epilepsy (TLE) is the most common form of intractable partial epilepsy in adults. Surgery (lobectomy or amygdalohippocampectomy) is effective in most patients. However, some complications can occur and brain shift, hematoma into the post operative cavity and occulomotor nerve palsy have been reported due to the surgical technic. We report the technique, safety and efficacy of temporal disconnection in nonlesional TLE. Forty-seven patients (18 males, 29 females; handedness: 12 left, 33 right; aged 35 years+/-10; mean duration of epilepsy: 24+/-10 years) underwent temporal disconnection (20 left, 27 right) guided by neuronavigation. Sixteen patients (35 %) underwent additional presurgical evaluation with SEEG. The outcome was assessed using Engel's classification. At the two-year follow-up, 85 % of the patients were seizure-free (Engel I), 26 (58 %) of whom were Ia. Postoperative persistent morbidity included mild hemiparesis (n=1), mild facial paresis (n=1), quadranopsia (n=23) and hemianopia (n=1). Verbal memory worsened in 13 % of cases when the disconnection was performed in the dominant lobe. MRI follow-up showed two cases of nonsymptomatic thalamic or pallidal limited ischemias, two cases of temporal horn-cystic dilatation, one requiring surgical reintervention without sequelae. There was one case of postoperative phlebitis. In the seizure-free patient group, postoperative EEG showed interictal temporal spikes at three months, one year and two years located in the anterior temporal region. Temporal disconnection is effective, prevents the occurrence of subdural cyst and hematomas in the temporal cavity, prevents the occurrence of oculomotor palsy, and limits the occurrence of quadranopsia. However, comparative studies are required to evaluate temporal disconnection as an alternative to lobectomy in nonlesional TLE.

Identifier les mécanismes physiopathologiques des altérations des activations péritumorales en IRM fonctionnelle (IRMf). Vingt-et-un patients opérés d’une tumeur cérébrale primitive frontale ou pariétale, respectant le cortex sensori-moteur primaire (gliome de bas grade (n = 6), de haut grade (n = 6), méningiome (n = 9)) ont exécuté des tâches motrices simples en IRMf BOLD. Contrôle en IRM de la perfusion cérébrale et de la réponse BOLD à l’inhalation de carbogène. Analyses BOLD par SPM5 et de la perfusion par ajustement gamma-dérivé (cartographies des débits (DSC) et volumes sanguins cérébraux (VSC), temps de transit moyen (TTM)). Les activations sensori-motrices primaires obtenues lors des mouvements controlatéraux étaient altérées dans l’hémisphère ipsitumoral. Ces altérations étaient liées à la proximité tumorale, à la nature tumorale et en particulier à l’existence d’une prise de contraste lésionnelle. Il n’y avait pas de relation avec la perfusion tumorale ou du cortex sensorimoteur sous-jacent à l’exception d’un allongement du TTM cortical en présence de méningiome. Ces altérations étaient également corrélées aux altérations des réponses BOLD corticales au carbogène. Ces résultats confirment l’existence d’altérations des activations péritumorales en IRMf pour des tumeurs qui prennent le contraste, l’intérêt du contrôle du signal BOLD au carbogène et suggèrent des mécanismes physiopathologiques différents selon la nature tumorale.

Stimulation of the thalamic nucleus ventralis intermedius (Vim) at high (130-Hz) frequency has been used over the last 8 years as a treatment in 134 patients with movement disorders (91 Parkinson's disease [PD], 23 essential tremor [ET], 21 various dyskinesias and dystonias, including four multiple sclerosis [MS]), implanted with long-term electrodes connected to a programmable stimulator. In PD patients, tremor was selectively suppressed for < or = 11 years. In ET patients, results were satisfactory, but in 35% of the cases deteriorated with time, when tremor had an action component. Other types of dyskinesias were much less influenced. Sixty-eight patients were bilaterally implanted, and 14 were implanted contralateral to a previous thalamotomy. Side effects were often minor, well tolerated, and immediately reversible. Three secondary scalp infections led to temporary removal of implanted material. There was no permanent morbidity. Long-term Vim stimulation, which is reversible, adaptable, and well tolerated, even by bilaterally operated-on (68 of 134) and by elderly patients, should replace thalamotomy in the regular surgical treatment of parkinsonian and essential tremors. More recently, we stimulated the subthalamic nucleus (STN) in 51 patients (44 bilateral) and the globus pallidus internus (GPi) in 12 patients (seven bilateral). STN stimulation has a spectacular effect on akinesia and rigidity and may improve the patients so as to maintain them all day at a level similar to their best "on" periods. A 30-50% reduction in drug dosage was possible in most of the patients. GPi stimulation has indications and effects similar to those of pallidectomy: abnormal involuntary movements are totally suppressed, whereas effects on akinesia and rigidity are not so important as they are with STN stimulation. For all three targets, morbidity is low and reversible, even when bilateral implantations are performed. The deep-brain stimulation method has now proved its safety as compared with ablative surgery and is able to provide a significant improvement to these severely disabled patients. Long-term follow up is establishing the security of the method, which should be considered in earlier stages of the disease actively to participate to rehabilitation.

L’empyème intracrânien est une complication fréquente des affections ORL (oto-rhino-laryngologie). Les empyèmes intracrâniens, n’ont fait l’objet que de peu de travaux ces dernières années au Sénégal. Malgré les nouvelles techniques d’imagerie, cette affection pose encore des problèmes diagnostiques, thérapeutiques et de suivi dans nos régions. Cet article rapporte notre expérience confrontée à une revue de la littérature, en mettant l’accent sur les aspects épidémiologiques, les difficultés diagnostique et thérapeutique, et le pronostic.Il s’agit d’une étude rétrospective, réalisée de janvier 2008 à décembre 2011 portant sur 100 observations cliniques. Le diagnostic était posé grâce au scanner cérébral. Le traitement était à 21 % médical exclusif et à 79 % combiné à la chirurgie. La durée du traitement était de 4 à 8 semaines. La surveillance clinique et scannographique était de 12 mois.L’empyème représentait 44,4 % des suppurations collectées intracrâniennes. L’âge moyen était de 21 ans. La porte d’entrée était 35 % ORL, 10 % méningitique et 25 % inconnue. Le siège était 57 % sous-dural, 22 % extra-dural et 10 % inter-hémisphérique. L’empyème était associé à un abcès dans 7 cas. Un cas était situé dans la fosse cérébrale postérieure. L’évolution était favorable dans 78 %, 12,5 % ont présenté des séquelles neurologiques, 11 % sont décédés et 3 % ont présenté une récidive.La fréquence des empyèmes intracrâniens reste encore très élevée au Sénégal. Les difficultés de prise en charge du point de vue diagnostique, thérapeutique et économique font toute la gravité de cette affection. Malgré ces aléas, un schéma thérapeutique bien conduit et précoce est la seule garantie d’une réduction de la morbi-mortalité de cette affection qui touche particulièrement le sujet jeune.Intracranial empyema is a frequent complication of ear-nose-throat (ENT)infections. Limited studies have been carried-out on cerebral empyema during recent years in Senegal. Despite new imaging techniques, diagnostic and therapeutic problems as well as outcome still remain in our regions. We report our experience compared to that of the literature. The study focused on epidemiological aspects, difficulties in diagnosis and treatment as well as prognosis of this condition.This was a retrospective study conducted from January 2008 to December 2011 of 100 clinical cases. Diagnosis was made based on contrast CT-scan. Twenty-one percent of patients received medical treatment alone, while 79% underwent surgery. The duration of the treatment varied from 4 to 8 weeks. The follow-up was clinical and radiological with a mean follow-up time of 12 months.Cerebral empyema represented 44.4 % of all intracranial suppuration cases and the mean age was 21 years. The etiology was ENT in 35%, meningitis 10%, unknown 25%. Localization was sub-dural in 57%, extra-dural in 22%, inter-hemispheric in 10% of the cases. Empyema was associated with an abscess in 7 cases. One case was located in the posterior fossa. The evolution was favorable in 78% of the cases and in 12.5% some neurologic sequelae were observed. Eleven patients died and 3% of the patients had recurrences.The frequency of intracranial empyema is still high in Senegal. Difficulties in diagnosis, therapeutics and low economic incomes account for the gravity of intracranial empyema. In spite of these risks, early stage and effective treatment is necessary to reduce the morbi-mortality, especially in young aged children.

It is becoming increasingly clear that attention-demanding tasks engage not only activation of specific cortical regions but also deactivation of other regions that could interfere with the task at hand. At the same time, electrophysiological studies in animals and humans have found that the participation of cortical regions to cognitive processes translates into local synchronization of rhythmic neural activity at frequencies above 40 Hz (so-called gamma-band synchronization). Such synchronization is seen as a potential facilitator of neural communication and synaptic plasticity. We found evidence that cognitive processes can also involve the disruption of gamma-band activity in high-order brain regions. Intracerebral electroencephalograms were recorded in 3 epileptic patients during 2 reading tasks. Visual presentation of words induced a strong deactivation in a broad (20-150 Hz) frequency range in the left ventral lateral prefrontal cortex, in parallel with gamma-band activations within the reading network, including Broca's area. The observed energy decrease in neural signals was reproducible across patients. It peaked around 500 ms after stimulus onset and appeared subject to attention-modulated amplification. Our results suggest that cognition might be mediated by a coordinated interaction between regional gamma-band synchronizations and desynchronizations, possibly reflecting enhanced versus reduced local neural communication.

Temporal 'plus' epilepsies are characterized by seizures involving a complex epileptogenic network including the temporal lobe and the closed neighboured structures such as the orbito-frontal cortex, the insula, the frontal and parietal operculum and the temporo-parieto-occipital junction. Temporal 'plus' epilepsies are currently identified by means of intracerebral electrodes but whether their diagnosis can be suspected non-invasively has not been evaluated yet. The aim of this retrospective study was to address this issue in 80 consecutive patients who were thought to suffer from non-lesional temporal lobe seizures which finally proved, on the basis of stereotactic intracerebral EEG (SEEG) recordings, to be 'purely' temporal (TL group, n = 58) or temporal 'plus' (T+ group, n = 22). Our results showed that the two groups of patients were difficult to differentiate on the basis of general clinical features or MRI data. Even the presence of hippocampal sclerosis did not distinguish the two groups. Conversely, both ictal clinical symptoms and scalp-EEG findings significantly differentiated TL from T+ patients. Patients with TL epilepsies more frequently presented an ability to warn at seizure onset (P = 0.003), an abdominal aura (P = 0.05), gestural automatisms (P = 0.04) and a post-ictal amnesia (P = 0.02). Patients suffering from T+ epilepsies more frequently had gustatory hallucinations (P = 0.02), rotatory vertigo (P = 0.02) and auditory illusions (P = 0.02) at seizure onset; they exhibited more frequently contraversive manifestations of the eyes and/or head (P = 0.001), piloerection (P = 0.03) and ipsilateral tonic motor signs (P = 0.05), and they were more often dysphoric in the post-ictal phase (P = 0.0001). Cluster analysis mainly indicated that some associations of symptoms were relevant for differentiating TL cases from T+ cases. Interictal EEG of T+ patients more frequently exhibited bilateral or precentral abnormalities, while ictal EEG more frequently pointed over the anterior frontal, temporo-parietal and precentral regions. Neither TL interictal spikes, nor TL ictal EEG onset, allowed us definitely to rule out the possibility of T+ epilepsies. Our findings may be useful for identifying, among patients suffering from 'atypical' non-lesional TL epilepsies, those who should undergo invasive recordings before surgery.