La prise en charge actuelle du trouble déficit de l'attention/hyperactivité (TDA/H) repose principalement sur la pharmacothérapie. Le méthylphénidate est le psychostimulant ayant l'AMM en France chez l'enfant et l'adolescent (mais pas chez l'adulte). Dans le cas d'une réponse incomplète au méthylphénidate, de contre-indications, d'une mauvaise tolérance faisant nécessiter une diminution des posologies ou un arrêt du traitement, de refus du traitement ou chez l'adulte, des alternatives thérapeutiques doivent être mises en place. Les alternatives utilisées jusqu'à présent, principalement de type éducation thérapeutique et remédiation cognitive, ne permettent pas d'atteindre les réponses thérapeutiques obtenues par le méthylphénidate. Dans ce contexte, les techniques de stimulation cérébrale non invasives ont été envisagées comme thérapeutique du TDA/H. Nous avons réalisé en février 2016 une recherche des études explorant l'utilisation de la stimulation magnétique transcrânienne répétitive (rTMS) et de la transcranial direct current stimulation (tDCS) dans la prise en charge du TDA/H. Les publications ont été recensées à partir de la base de données électronique Pubmed grâce à une équation de recherche associant les termes Medical Subject Headings (Mesh) suivants : « attention-deficit disorder with hyperactivity » et « transcranial magnetic stimulation » pour la rTMS et « attention-deficit disorder with hyperactivity » et « transcranial direct current stimulation » pour la tDCS. Suivant nos critères d'inclusion, cinq études ont été retenues sur la rTMS et quatre sur le tDCS. La rTMS a été utilisée avec une efficacité significative dans quatre des cinq études. Elle pourrait s'envisager en complément du traitement médicamenteux chez les patients ayant des symptômes persistants ou des altérations cognitives associées ou bien en traitement de deuxième intention chez ceux présentant une mauvaise tolérance ou une inefficacité des psychostimulants. La tDCS a été utilisée avec une efficacité significative dans trois des quatre études. La tDCS pourrait s'avérer utile pour améliorer les altérations cognitives de certains patients, utilisée seule ou en association avec des techniques de remédiation cognitive. Cependant des études d'efficacité supplémentaires sont nécessaires pour asseoir le niveau de preuve de la rTMS et de la tDCS dans le TDA/H ainsi que leurs places dans les stratégies thérapeutiques actuelles.The aim of this review is to summarize the available data in the literature about the therapeutic applications of transcranial magnetic stimulation and transcranial direct current stimulation in attention-deficit hyperactivity disorder (ADHD).The scientific literature search of international articles was performed in February 2016 using the PubMed electronic database. The following MeSH terms were employed: "attention-deficit disorder with hyperactivity" AND "transcranial magnetic stimulation", "attention-deficit disorder with hyperactivity" AND "transcranial direct current stimulation".Five studies were retained by the literature search and were included in the review about rTMS and ADHD. Except for one study, they all showed significant positive effects of rTMS on ADHD. Four studies were retained by the literature search and were included in the review about tDCS and ADHD. Three of them showed significant positive effects of tDCS on ADHD. Two of them used tDCS during sleep at a frequency < 1 Hz. Only low-level evidences are available to support treatment with rTMS or tDCS in patients with ADHD. Indeed, randomized controlled trials are rare in this field of research.Additional studies are needed to confirm the efficacy of rTMS and tDCS in ADHD. rTMS could be used as an alternative therapy when methylphenidate is not well tolerated or shows an insufficient efficacy. Nevertheless, the optimal target, frequency and duration remain to be determined. tDCS can modulate attention in healthy subjects but data are insufficient in ADHD to conclude. It could be interesting to study its use in association with cognitive remediation to enhance its cognitive efficacy.

Progressive multifocal leukoencephalopathy (PML) occurred in two patients after kidney transplantation. Two years after such a transplantation associated with immunosuppressive chemotherapy, a 54-year-old male developed polyneuropathy, diffuse alterations of the central nervous system and he died with the suspicion of hypertensive encephalopathy due to progressive renal failure. A 45-year-old female had kidney transplantation first complicated by Listeria monocytogenes meningoencephalitis. She was cured from this disease and had a satisfactory social rehabilitation for two years. Afterwards, she suffered from various neurological ailments, including epilepsy, that were attributed to combined renal failure and developing hydrocephalus. One year after the onset of these neurological symptoms, the grafted kidney was removed and chemotherapy was discontinued but she died a few weeks later. Both patients had typical PML. By electron microscopy, performed on formalin fixed brain tissue, intranuclear round particles (40-50 nm) could be recognized in the first case only. These two cases are confronted with the six published observations of PML following organ transplantation. The frequency of PML has been estimated at 1 for 5000 kidney transplantation, 1 for 2000 chronic lymphoid leukemia and 1 for 10,000 Hodgkin's disease.

The authors report on a 37 year old right-handed patient with a right rolando-parietal infarct which was manifest clinically by not only sensory-motor disorders of the left side of the body, but more especially by an expression aphasia. This observation fulfills the criteria for defining the exceptional case of crossed aphasia in a right-handed patient: aphasic destruction of language engendered by a right unilateral lesion in such a patient, without a previous history of a cerebral lesion or family history of left-handedness. Comparing the aphasic signs in this patient with the rare cases reported in the published literature shows that there is a particular pathognomonic profile, close to the type of aphasic disorganization seen in children and left-handed adults. The authors review the neuropsychopathogenic explanations for this crossed aphasia of right-handed patients.

The authors report the anatomical and clinical findings in a 65 year old patient with a lesion in the hypothalamus presenting mainly as disorders in heat and water regulation. Disorders in heat regulation dominated the clinical picture, in relation to a poikilothermia. Conservation of reactivity to pyrogenic bacteria is debatable. Inappropriate secretion of antidiuretic hormone (ISADH) by a direct effect on the supraoptico-hypophyseal aixs can account for the water and electrolyte disturbances. The anatomical lesions, due to hypothalamic changes, can be included in the circumscribed proliferative reticuloses of the CNS having a pseudo-inflammatory histological appearance.