Revue neurologique最新文献

英文中文

Can a virtual reality tool detect minor executive functions impairment in patients with multiple sclerosis? 虚拟现实工具能否检测多发性硬化症患者的轻微执行功能障碍？

IF 2.3 4区医学 Q2 CLINICAL NEUROLOGY

Revue neurologique

Pub Date : 2025-09-01 Epub Date: 2025-07-23 DOI: 10.1016/j.neurol.2025.06.009

R. Delsanti , E. Le Mercier , A. Briant , N. Derache , C. Arnaud , P. Branger , G. Defer

Introduction

Traditional neuropsychological tests do not always identify executive disorders in patients with multiple sclerosis (MS), despite their complaints. Many studies suggest that virtual reality (VR) may be useful to evaluate cognitive functions as close as possible to patients’ daily activities. We investigated the validity of a VR tool in the assessment of executive impairment in MS patients.

Methods

Thirty patients with relapsing-remitting multiple sclerosis (RRMS) and 30 matched healthy controls performed a shopping task using the Virtual Action Planning-Supermarket (VAP-S) which simulates a supermarket environment (main measures: total test duration, distance traveled, incorrect actions, number of stops, duration of stops and time to pay) with a familiarization phase followed by a test phase. In addition, neuropsychological tests assessing executive functions were proposed. Inter-group comparisons were conducted using adapted statistical tests and correlation analyses between the VAP-S and the traditional tests results were performed.

Results

No significant difference was observed between the two groups in traditional tests. However, during the VAP-S familiarization phase, RRMS patients performed worse than controls, showing differences in distance traveled (P = 0.042), total test duration (P = 0.021) and number of stops (P = 0.034). In the VAP-S test phase, no difference was found. Correlations were observed between some of the VAP-S scores and traditional tests results in both groups.

Conclusion

A VR tool appears to be more effective than traditional tests in detecting mild executive difficulties in MS patients. We noticed a learning effect during the test phase, suggesting that VR could support cognitive rehabilitation and improve daily living.

传统的神经心理学测试并不总是识别多发性硬化症（MS）患者的执行障碍，尽管他们的抱怨。许多研究表明，虚拟现实（VR）可能有助于评估尽可能接近患者日常活动的认知功能。我们调查了VR工具在评估多发性硬化症患者执行功能障碍中的有效性。方法：30例复发-缓解型多发性硬化症（RRMS）患者和30例匹配的健康对照者使用虚拟行动计划-超市（vv - s）进行购物任务，该虚拟行动计划-超市模拟超市环境（主要测量指标：总测试时间、行进距离、错误行为、停车次数、停车时间和付款时间），并进行熟悉阶段和测试阶段。此外，还提出了评估执行功能的神经心理测试。采用适应性统计检验进行组间比较，并对VAP-S与传统检验结果进行相关性分析。结果：两组在传统试验中差异无统计学意义。然而，在VAP-S熟悉阶段，RRMS患者的表现比对照组差，表现出旅行距离（P=0.042），总测试时间（P=0.021）和停止次数（P=0.034）的差异。在VAP-S测试阶段，没有发现差异。在两组中观察到一些VAP-S评分与传统测试结果之间的相关性。结论：在检测MS患者轻度执行困难方面，VR工具似乎比传统测试更有效。在测试阶段，我们注意到一个学习效果，这表明VR可以支持认知康复和改善日常生活。

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引用次数: 0

Prevalence and management of psychosis in an outpatient population with Parkinson's disease: A real-life descriptive study 帕金森病患者门诊人群精神病的患病率和管理：一项真实的描述性研究。

IF 2.3 4区医学 Q2 CLINICAL NEUROLOGY

Revue neurologique

Pub Date : 2025-09-01 Epub Date: 2025-07-16 DOI: 10.1016/j.neurol.2025.06.008

G. Costentin , M. Diguet , D. Wallon , L. Grangeon , D. Maltête

Background

Previous studies reporting prevalence of psychosis were predominantly cross-sectional, with a limited focus on the full spectrum of features seen in psychosis associated with Parkinson's disease (PDPsy).

Objectives

To assess the prevalence of PDPsy, explore the association of PDPsy with demographic, drug-related, and disease-related characteristics and describe the management of PDPsy in an outpatient population with PD.

Methods

We analysed the psychosis prevalence and clinical correlates in PD patients seen for an outpatient visit at the Parkinson Expert Centre of Rouen. PD patients were evaluated with detailed clinical history taken by an investigator trained in PD (DM). Psychosis was diagnosed according to NINDS diagnostic criteria. PDPsy characteristics were collected using a standardized questionnaire composed of ten qualitative items on hallucinations, minor phenomena, and delusions. All PD patients considered to have a previous or ongoing PDPsy underwent an interview to assess the age at onset, exacerbating and relieving factors, the management and outcomes.

Results

From June to December 2021, 315 outpatients with PD were included in the study, 42% had previous or ongoing psychosis, mostly visual hallucinations. PD patients with PDPsy were older, with a more advanced form of the disease and were treated with a higher dose of anti-Parkinson drugs. Psychotic symptoms can be adequately managed with nonpharmacoligical approaches, while in other patients, reduction or withdrawal of drugs, or introduction of clozapine was necessary.

Conclusions

Untreated PDPsy is associated with impaired quality of life, and significant distress to caregivers and patients. Early detection of psychotic symptoms may yield prognostic and therapeutic benefits.

背景：先前报道精神病患病率的研究主要是横断面的，对帕金森病（PDPsy）相关精神病的全谱特征关注有限。目的：评估PDPsy的患病率，探讨PDPsy与人口学、药物相关和疾病相关特征的关系，并描述门诊PD患者PDPsy的处理。方法：我们分析了鲁昂帕金森专家中心门诊PD患者的精神病患病率和临床相关因素。PD患者由经过PD （DM）培训的研究者根据详细的临床病史进行评估。根据NINDS诊断标准诊断精神病。采用标准化问卷收集PDPsy的特征，问卷由十个关于幻觉、轻微现象和妄想的定性项目组成。所有被认为有既往或正在进行的PD患者都接受了访谈，以评估发病年龄、加重和缓解因素、管理和结果。结果：2021年6月至12月，315例门诊PD患者纳入研究，42%既往或持续患有精神病，以视幻觉为主。患有PDPsy的PD患者年龄更大，病情更严重，接受更高剂量的抗帕金森药物治疗。精神病症状可以通过非药物方法得到充分控制，而在其他患者中，减少或停药或引入氯氮平是必要的。结论：未经治疗的PDPsy与生活质量受损有关，并对护理者和患者造成重大困扰。早期发现精神病症状可能带来预后和治疗益处。

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引用次数: 0

Criteria for the use of plasmapheresesis in optic neuritis: A practice review from French expert centers 视神经炎血浆置换的使用标准：法国专家中心的实践回顾。

IF 2.3 4区医学 Q2 CLINICAL NEUROLOGY

Revue neurologique

Pub Date : 2025-09-01 Epub Date: 2025-07-15 DOI: 10.1016/j.neurol.2025.06.005

A. Gaulier , V. Touitou , M.-B. Rougier , M.P. Robert , H. Merle , M. Aubart , P. Cabre , C. Cochard , N. Stolowy , J. De Seze , A. Gueguen , J. Aboab , H. Zephir , A. Ungureanu , A. Caignard , C. Scherer , M. Gobert , S. Saheb , N. Fage , J.-B. Ducloyer , P. Lebranchu

Introduction

Some patients remain severely disabled after an episode of optic neuritis. Several studies have shown that plasmapheresis (PE) can improve visual prognosis in the absence of satisfactory recovery after corticosteroids. However, there is no clear ophthalmological criterion for doing PE, and practices vary widely. The objective of the present study was to better define the rationales for use of PE.

Material and methods

We investigated the real-life indications for PE in French expert centers. Based on the responses to a questionnaire and the current literature, we further provided guidelines aiming to standardize the use of PE for the management of optic neuritis.

Results

Twenty expert centers completed the questionnaire. Together, they accounted for 90% of patients treated by PE in France during the study period. The main criteria for using PE were as follows: severely impaired visual acuity despite corticosteroids (mean visual acuity < 0.6 logMAR or 20/80), high suspicion for neuromyelitis optica spectrum disorder, bilateral optic neuritis, or a profound visual field alteration.

Conclusion

This study provides insightful information about the real-life indications for PE in French centers for the treatment of optic neuritis. Based on our findings and the available data in the literature, we provide a decision-making algorithm for the management of optic neuritis.

简介：一些患者在视神经炎发作后仍然严重残疾。一些研究表明，在皮质类固醇治疗后视力恢复不理想的情况下，血浆置换（PE）可以改善视力预后。然而，没有明确的眼科标准做体育，实践差异很大。本研究的目的是更好地定义使用PE的理由。材料和方法：我们调查了法国专家中心PE的现实适应症。根据问卷调查结果和现有文献，我们进一步提供了指导方针，旨在规范视神经炎治疗中PE的使用。结果：20家专家中心完成问卷调查。在研究期间，他们合计占法国PE治疗患者的90%。使用PE的主要标准如下：尽管使用皮质类固醇，但视力严重受损（平均视力）结论：本研究为法国视神经炎治疗中心的PE现实适应症提供了有见地的信息。基于我们的发现和文献中的可用数据，我们提供了视神经炎管理的决策算法。

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引用次数: 0

MRI features of pleomorphic xanthoastrocytoma defined by DNA methylation profile 由DNA甲基化谱确定的多形性黄质星形细胞瘤的MRI特征。

IF 2.3 4区医学 Q2 CLINICAL NEUROLOGY

Revue neurologique

Pub Date : 2025-09-01 Epub Date: 2025-06-04 DOI: 10.1016/j.neurol.2025.04.009

R. Fawaz , O. Aboubakr , F.N. El Sissy , B. Mathon , B.M. Oumoussa , B. Barka , E. Mandonnet , D. Leclercq , M. Touat , K. Hoang-Xuan , H. Adle-Biassette , F. Bielle , L. Nichelli

Introduction

Pleomorphic xanthoastrocytomas (PXA) are primary brain tumors challenging to diagnose due to their morphological and molecular overlap with other tumors. While DNA methylation profiling (MP) aids pathological classification, it alone may be inconclusive. Magnetic resonance imaging (MRI), routinely performed for lesion assessment, provides valuable information. Combining histo-molecular features, MP, and MRI is thus beneficial, particularly in cases of diagnostic uncertainty. In this study, we retrospectively analyzed MRI features of methylation-confirmed PXAs (mcPXAs) versus tumors with PXA-like histology using WHO 2021 criteria.

Methods

We included 29 adult patients with tumors displaying PXA-suggestive histology, completed MP, and preoperative MRI. Tumors were classified into three groups: mcPXA, histological PXA with methylation-confirmed glioblastoma (mcGBM), and other MP-confirmed diagnoses (mcMimic). Clinical and molecular data were recorded.

Results

All tumors were supratentorial with heterogeneous enhancement. The mcGBM group showed significantly more peritumoral edema and hypercellularity than mcPXA (P = 0.002 and P = 0.023). No significant differences were found in tumor location, cystic components, or hemorrhagic content. The BRAF^V600E mutation appeared in 89% of mcPXA, 8% of mcGBM, and 29% of mcMimic cases (P < 0.05). Our composite MRI and molecular score for PXA diagnosis achieved an area under the curve of 0.95, with 95% specificity and 77% sensitivity.

Conclusion

In cases of histological uncertainty, lack of peritumoral edema and hypercellularity supports a PXA epigenetic profile. Our specific score could aid in challenging cases, though further validation in larger cohorts is warranted.

简介：多形性黄色星形细胞瘤（PXA）是一种原发性脑肿瘤，由于其形态和分子与其他肿瘤有重叠，诊断难度很大。虽然DNA甲基化谱（MP）有助于病理分类，但它本身可能不具有决定性。磁共振成像（MRI），常规进行病变评估，提供有价值的信息。因此，结合组织分子特征、MP和MRI是有益的，特别是在诊断不确定的情况下。在这项研究中，我们使用WHO 2021标准回顾性分析了甲基化证实的pxa （mcpxa）与pxa样组织学肿瘤的MRI特征。方法：我们纳入了29例具有pxa提示组织学，完成MP和术前MRI的成年肿瘤患者。肿瘤分为三组：mcPXA、组织学PXA伴甲基化证实的胶质母细胞瘤（mcGBM）和其他mp确诊诊断（mcMimic）。记录临床和分子数据。结果：所有肿瘤均位于幕上，呈非均匀强化。mcGBM组肿瘤周围水肿和细胞增生明显多于mcPXA组（P=0.002和P=0.023）。在肿瘤位置、囊性成分或出血内容方面没有发现显著差异。BRAFV600E突变出现在89%的mcPXA、8%的mcGBM和29%的mcMimic病例中(结论：在组织学不确定的病例中，缺乏肿瘤周围水肿和高细胞性支持PXA的表观遗传谱。我们的具体评分可以帮助在具有挑战性的情况下，尽管进一步验证在更大的队列是必要的。

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引用次数: 0

When sound replaces pain: A case of exploding head syndrome mistaken for headache 当声音代替疼痛：爆头综合征误诊为头痛一例。

IF 2.3 4区医学 Q2 CLINICAL NEUROLOGY

Revue neurologique

Pub Date : 2025-09-01 Epub Date: 2025-06-24 DOI: 10.1016/j.neurol.2025.06.002

L. Salaun , I. Ghorayeb

引用次数: 0

Rethinking Parkinson's disease therapy: The overlooked role of GPR143 in L-DOPA effects 重新思考帕金森病治疗：GPR143在左旋多巴作用中被忽视的作用。

IF 2.3 4区医学 Q2 CLINICAL NEUROLOGY

Revue neurologique

Pub Date : 2025-09-01 Epub Date: 2025-07-09 DOI: 10.1016/j.neurol.2025.07.001

M. Aubignat

引用次数: 0

Zilucoplan as a fast-acting treatment for severe myasthenic exacerbation: A case series Zilucoplan作为严重肌无力加重的速效治疗：一个病例系列。

IF 2.3 4区医学 Q2 CLINICAL NEUROLOGY

Revue neurologique

Pub Date : 2025-09-01 Epub Date: 2025-07-19 DOI: 10.1016/j.neurol.2025.06.010

V. Fabry , B. Acket , P. Girardie , L. Espagno , O. Cointault , P. Cintas

引用次数: 0

Data linkage between the French multiple sclerosis cohort (OFSEP) and the French national health insurance database (SNDS) 法国多发性硬化症队列（OFSEP）和法国国家健康保险数据库（SNDS）之间的数据链接。

IF 2.3 4区医学 Q2 CLINICAL NEUROLOGY

Revue neurologique

Pub Date : 2025-09-01 Epub Date: 2025-06-06 DOI: 10.1016/j.neurol.2025.05.002

E. Leray , E. Drezen , R. Casey , S. Vukusic , on behalf of Ofsep

Background

Linking disease registries to nationwide healthcare administrative databases increases the research opportunities. Recent guidelines emphasize the need of transparency in this process.

Objective

Our aims were to describe the process of record linkage between the French multiple sclerosis (MS) cohort (OFSEP) and the national health insurance database (SNDS) and to evaluate the linkage quality.

Methods

As no unique identifier was available in the two databases, the OFSEP-SNDS data linkage was performed by indirect matching using the following sixteen patient variables to create a unique key: sex, dates of birth and death, of visits to a neurologist, of MS-related hospitalizations, of MRI, and use of disease-modifying therapies. Three indicators were computed to assess the linkage quality.

Results

Among the 52,034 eligible patients in the OFSEP registry, 42,603 (81.9%) were matched with patients in the SNDS database, with good overall quality (robustness = 3.19; this is the number of linkage variables that can be removed without losing the uniqueness of the linked pair; 87.8% of common information). Comparison of the linked and unlinked populations revealed no major selection bias regarding age and sex distributions.

Conclusion

The successful linkage of more than 40,000 patients with MS broadens the research perspectives by allowing access to a wide range of clinical and administrative data (e.g., comorbidities, care pathways) over a long mean disease duration (> 15 years).

背景：将疾病登记与全国卫生保健管理数据库联系起来增加了研究机会。最近的指导方针强调这一进程必须具有透明度。目的：我们的目的是描述法国多发性硬化症（MS）队列（OFSEP）与国家健康保险数据库（SNDS）之间的记录链接过程，并评价链接质量。方法：由于两个数据库中没有唯一标识符，OFSEP-SNDS数据链接通过使用以下16个患者变量间接匹配来创建唯一关键：性别、出生和死亡日期、神经科医生就诊次数、ms相关住院次数、MRI和使用疾病改善疗法。计算了三个指标来评估联动质量。结果：在OFSEP登记的52,034例符合条件的患者中，42,603例（81.9%）与SNDS数据库中的患者匹配，总体质量良好(鲁棒性=3.19；这是可以在不失去链接对唯一性的情况下移除的链接变量的数量；常用信息占87.8%)。对关联人群和非关联人群的比较显示，在年龄和性别分布方面没有重大的选择偏差。结论：超过40,000名MS患者的成功关联拓宽了研究视角，允许获得广泛的临床和管理数据（例如，合并症，护理途径），平均疾病持续时间较长（约15年）。

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引用次数: 0

Epileptic seizures recorded with microelectrodes: A persistent multiscale gap between neuronal activity, micro-, and macro-LFP? 微电极记录的癫痫发作：神经元活动、微观和宏观lfp之间的持续多尺度差距？

IF 2.8 4区医学 Q2 CLINICAL NEUROLOGY

Revue neurologique

Pub Date : 2025-06-01 Epub Date: 2025-04-30 DOI: 10.1016/j.neurol.2025.01.414

P. Calvat , E.J. Barbeau , A. Darves-Bornoz , M. Denuelle , L. Valton , J. Curot

The cascade of events that occur in the human brain, from neurons to local circuits and global network dynamics during epileptic seizures, is barely understood. Ictogenesis in humans has been described in relation to electrophysiological concepts based on local field potentials (LFP) recorded by standard macroelectrodes (macro-LFP). Microelectrodes, however, record at the cellular scale. Despite over four decades of such recordings in patients with epilepsy, there remains a significant gap between these scales. This narrative review explores the contribution of microelectrode recordings of seizures in humans. By focusing closely on neuronal activity, researchers often overlook that microelectrodes also allow recording LFP at the micro-electrode level (micro-LFP). Above all, there is a gap between local circuits recorded at the micro-LFP level and large-scale network dynamics at the macro-LFP level, with little theoretical work to reconcile these two scales. Consequently, to date, analyses of seizures have been coarse, incomplete, and based on small numbers of patients. In particular, most multiscale seizure analyses have not included all three levels of scales (single units, micro-LFP, and macro-LFP) simultaneously, but doing so is key to providing a synthesis of ictal genesis. This review highlights the various challenges that face researchers using microelectrodes: (1) carrying out a systematic descriptive and quantitative analysis of the micro-LFP seizure signal, (2) improving the spatial correspondence between micro- and macroelectrodes in order to achieve better comparability between the two scales, (3) improving brain sampling thanks to specific devices, in particular deep electrodes with microwires, (4) reporting the reference electrode used in each study and how it may impact the results, (5) long duration of recordings over hours and days, and (6) shared simultaneous micro-LFP/macro-LFP databases.

在癫痫发作期间，从神经元到局部电路和全球网络动态，人类大脑中发生的级联事件几乎不为人所知。人类的Ictogenesis已经被描述为基于由标准大电极（macro-LFP）记录的局部场电位（LFP）的电生理学概念。然而，微电极在细胞尺度上记录。尽管在癫痫患者中已有40多年的此类记录，但这些量表之间仍然存在显着差距。这篇叙述性综述探讨了人类癫痫发作的微电极记录的贡献。通过密切关注神经元活动，研究人员经常忽略了微电极也允许在微电极水平（micro-LFP）记录LFP。最重要的是，在微观lfp水平上记录的局部电路与宏观lfp水平上记录的大规模网络动态之间存在差距，很少有理论工作来调和这两个尺度。因此，到目前为止，对癫痫发作的分析是粗糙的，不完整的，并且基于少数患者。特别是，大多数多尺度癫痫分析并没有同时包括所有三个层次的尺度（单个单位、微观lfp和宏观lfp），但这样做是提供癫痫发生综合的关键。这篇综述强调了使用微电极的研究人员面临的各种挑战：(1)对微lfp发作信号进行系统的描述和定量分析；(2)改善微观和宏观电极之间的空间对应关系，以便在两个尺度之间实现更好的可比性；(3)由于特定设备，特别是带有微丝的深层电极，改善了大脑采样；(4)报告每项研究中使用的参考电极及其对结果的影响；(5)记录时间长达数小时和数天；(6)同时共享微观/宏观lfp数据库。

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引用次数: 0

Granulomatous angiitis of the central nervous system (GANS) associated with Hodgkin lymphoma 中枢神经系统肉芽肿性脉管炎（GANS）与霍奇金淋巴瘤相关。

IF 2.8 4区医学 Q2 CLINICAL NEUROLOGY

Revue neurologique

Pub Date : 2025-06-01 Epub Date: 2025-04-25 DOI: 10.1016/j.neurol.2025.04.005

L. Jeantin , A. Laurenge , E. Lefevre , K. Mokhtari , M. Le Garff-Tavernier , A. Hesters , S. Ghazanfari , A. Méneret , D. Psimaras , K. Hoang-Xuan , M. Ouzegdouh , M. Touat

引用次数: 0

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