Highlights ► Transient prosopagnosia from human brain intracerebral stimulation is reported. ► The recognition impairment is specific to faces. ► The area stimulated is functionally defined as the ...right ‘occipital face area’. ► A face-sensitive N170 potential is recorded directly in this area.
•Mono segmental percutaneous screw fixation in the management of AoSpine thoracolumbar type B fractures in patient suffering from AS disease could be a safe stabilization method in most of ...cases.•Stabilization is efficient and last during follow up.•This surgery provides also short hospital stays, low blood loss, short operative time, and a fast rehabilitation.
To assess the viability and effectiveness of mono-segmental percutaneous screw fixation in the treatment of unstable type B thoracolumbar fracture due to ankylosing spondylitis.
We report here all 40 patients treated by mono-segmental screw fixation in this indication, between January 2018 and January 2022, with follow-up at 3 and 9 months. Study variables comprised operating time, length of stay, fusion, stabilization quality, and peri-operative morbidity and mortality.
One patient showed early displacement of rods caused by technical error. None of the others showed secondary displacement of rods or screws. Mean age was 73 years (range 18–93), mean hospital stay 4.8 days (range 2–15), mean operative time 52minutes (range 26–95minutes) and mean estimated blood loss 40ml. There were 2 deaths caused by intensive care unit complications. All patients except those in intensive care were verticalized within 24hours after surgery. Parker score was unchanged for each patient before and after surgery and during follow-up.
Mono-segmental percutaneous screw fixation in the treatment of unstable type B thoracolumbar fracture due to ankylosing spondylitis was safe and effective. This study showed that this surgery reduced length of hospital stay, operative time, blood loss and complications compared to open or extended percutaneous surgery, and allowed fast rehabilitation in this vulnerable population.
Surgery is an effective treatment for drug-resistant temporal-lobe epilepsy (TLE), but is still underutilized for older patients because of a perceived higher rate of perioperative complications, ...cognitive decline and worse seizure outcome.
We retrospectively screened all patients operated on in our institution for drug-resistant TLE between 2007 and 2019. Data of patients aged ≥50 years versus <50 years at surgery were compared. The primary endpoint was freedom from disabling seizure (Engel I) at 2 years postoperatively.
In patients aged ≥50 years (n=19), mean age at surgery was 54.9 years and mean disease duration was 36.6 years. At 2 years postoperatively, rates of Engel I seizure outcome were not significantly different between the two groups (73.9% in the <50 years group versus 94.4% in the ≥50 years group). Although surgical complications were significantly (47.4%) in the older patients, neurological deficit was permanent in only 5.3% of cases. At 1 year postoperatively, neuropsychological outcome did not significantly differ between the two groups.
Patients aged ≥50 years had an excellent seizure outcome at 2 years postoperatively. Early postoperative complications were more frequent in patients aged ≥50 years but were mostly transient. Cognitive outcome was similar to that in younger patients. These findings strongly suggest that age ≥50 years should not be an exclusion criterion for resective epilepsy surgery in patients with drug-resistant TLE.
Les épilepsies focales structurelles pharmacorésistantes avec crises pariétales représentent seulement 5 % des séries chirurgicales et moins de 10 % dans notre série de patients explorés en SEEG à ...Nancy. Ce sont des épilepsies de diagnostic difficile du fait de leur rareté et d’une symptomatologie riche témoignant d’une implication extrapariétale. Le diagnostic localisateur des crises peut donc être retardé voire conduire à une localisation erronée de la zone épileptogène.
À partir des corrélations anatomo-électrocliniques en SEEG, déterminer les signes critiques associés à la décharge critique pariétale initiale et à la propagation pariétale et extrapariétale.
Étude de deux patients implantés en SEEG présentant une épilepsie pariétale pharmacorésistante. Analyse de l’activité paroxystique enregistrée et de la clinique lors de la crise enregistrée en simultanée en vidéo.
La première patiente présente une symptomatologie sensitive unilatérale associée à une décharge limitée au cortex post-central. Le second patient présente une activité motrice dystonique et hyperkinétique concomitante d’une décharge pariétale avec une propagation lente intrapariétale (26 s) puis secondairement une propagation extrapariétale asymétrique (frontal ipsilatéral), contrairement aux crises frontales qui se caractérisent par une propagation bilatérale rapide.
Ces deux observations permettent de mettre évidence un pattern électroclinique orientant vers le lobe pariétal aussi bien au niveau des signes que de la dynamique. Ces conclusions sont à confirmer sur une série de patient plus importante.
Human face perception requires a network of brain regions distributed throughout the occipital and temporal lobes with a right hemisphere advantage. Present theories consider this network as either a ...processing hierarchy beginning with the inferior occipital gyrus (occipital face area; IOG-faces/OFA) or a multiple-route network with nonhierarchical components. The former predicts that removing IOG-faces/OFA will detrimentally affect downstream stages, whereas the latter does not. We tested this prediction in a human patient (Patient S.P.) requiring removal of the right inferior occipital cortex, including IOG-faces/OFA. We acquired multiple fMRI measurements in Patient S.P. before and after a preplanned surgery and multiple measurements in typical controls, enabling both within-subject/across-session comparisons (Patient S.P. before resection vs Patient S.P. after resection) and between-subject/across-session comparisons (Patient S.P. vs controls). We found that the spatial topology and selectivity of downstream ipsilateral face-selective regions were stable 1 and 8 month(s) after surgery. Additionally, the reliability of distributed patterns of face selectivity in Patient S.P. before versus after resection was not different from across-session reliability in controls. Nevertheless, postoperatively, representations of visual space were typical in dorsal face-selective regions but atypical in ventral face-selective regions and V1 of the resected hemisphere. Diffusion weighted imaging in Patient S.P. and controls identifies white matter tracts connecting retinotopic areas to downstream face-selective regions, which may contribute to the stable and plastic features of the face network in Patient S.P. after surgery. Together, our results support a multiple-route network of face processing with nonhierarchical components and shed light on stable and plastic features of high-level visual cortex following focal brain damage.
Brain networks consist of interconnected functional regions commonly organized in processing hierarchies. Prevailing theories predict that damage to the input of the hierarchy will detrimentally affect later stages. We tested this prediction with multiple brain measurements in a rare human patient requiring surgical removal of the putative input to a network processing faces. Surprisingly, the spatial topology and selectivity of downstream face-selective regions are stable after surgery. Nevertheless, representations of visual space were typical in dorsal face-selective regions but atypical in ventral face-selective regions and V1. White matter connections from outside the face network may support these stable and plastic features. As processing hierarchies are ubiquitous in biological and nonbiological systems, our results have pervasive implications for understanding the construction of resilient networks.
Abstract Parkinson's disease (PD) is known to affect postural control, especially in situations needing a change in balance strategy or when a concurrent task is simultaneously performed. However, ...few studies assessing postural control in patients with PD included homogeneous population in late stage of the disease. Thus, this study aimed to analyse postural control and strategies in a homogeneous population of patients with idiopathic advanced (late-stage) PD, and to determine the contribution of peripheral inputs in simple and more complex postural tasks, such as sensory conflicting and dynamic tasks. Twenty-four subjects with advanced PD (duration: median (M)=11.0 years, interquartile range (IQR)=4.3 years; Unified Parkinson's Disease Rating Scale (UPDRS): M “on-dopa”=13.5, IQR=7.8; UPDRS: M “off-dopa”=48.5, IQR=16.8; Hoehn and Yahr stage IV in all patients) and 48 age-matched healthy controls underwent static (SPT) and dynamic posturographic (DPT) tests and a sensory organization test (SOT). In SPT, patients with PD showed reduced postural control precision with increased oscillations in both anterior–posterior and medial–lateral planes. In SOT, patients with PD displayed reduced postural performances especially in situations in which visual and vestibular cues became predominant to organize balance control, as was the ability to manage balance in situations for which visual or proprioceptive inputs are disrupted. In DPT, postural restabilization strategies were often inefficient to maintain equilibrium resulting in falls. Postural strategies were often precarious, postural regulation involving more hip joint than ankle joint in patients with advanced PD than in controls. Difficulties in managing complex postural situations, such as sensory conflicting and dynamic situations might reflect an inadequate sensory organization suggesting impairment in central information processing.
To describe clinical outcomes of stereotactic body radiation therapy (SBRT) applied alone or as a boost after a conventionally fractionated radiation therapy (CFRT) for the treatment of bone ...oligometastases.
This retrospective cohort study included patients treated with SBRT from January 2007 to December 2015 in the Institut de cancérologie de Lorraine in France. The inclusion criteria involved adults treated with SBRT for one to three bone metastases from a histological proven solid tumor and a primary tumor treated, an Eastern Cooperative Oncology Group (ECOG) score inferior or equal to 2. Local control (LC), overall survival (OS), progression free survival (PFS), bone progression incidence (BPI), skeletal related events free survival (SRE-FS), toxicity and pain response were evaluated.
Forty-six patients and 52 bone metastases were treated. Twenty-three metastases (44.2%) received SBRT alone mainly for non-spine metastases and 29 (55.8%) a combination of CFRT and SBRT mainly for spine metastases. The median follow-up time was 22months (range: 4–89months). Five local failures (9.6%) were observed and the cumulative incidences of local recurrence at 1 and 2years respectively were 4.4% and 8% with a median time of local recurrence of 17months (range: 4–36months). The one- and two-years OS were 90.8% and 87.4%. Visceral metastasis (HR: 3.40, 95% confidence interval 1.10–10.50) and a time from primary diagnosis (TPD)>30months (HR: 0.22 0.06–0.82) were independent prognostic factors of OS. The 1 and 2years PFS were 66.8% and 30.9% with a median PFS time of 18months 13–24. The one- and two-years BPI were 27.7% and 55.3%. In multivariate analysis, unfavorable histology was associated with worse BPI (HR: 3.19 1.32–7.76). The SRE-FS was 93.3% and 78.5% % at 1 and 2years. The overall response rate for pain was 75% in the evaluable patients (9/12). No grade≥3 toxicity nor especially no radiation induced myelopathy (RIM), two patients developed asymptomatic vertebral compression fractures.
The sole use of SBRT or its association with CFRT is an efficient and well-tolerated treatment that allows high LC for bone oligometastases.
Décrire les résultats de la radiothérapie stéréotaxique seule ou en association avec une radiothérapie conformationnelle de fractionnement standard dans le traitement des oligométastases osseuses.
Cette étude de cohorte rétrospective a inclus des patients traités par irradiation stéréotaxique entre janvier 2007 et décembre 2015 à l’Institut de cancérologie de Lorraine. Les adultes avec un score selon l’Eastern Cooperative Oncology Group inférieur ou égal à2, atteints d’une à trois métastases osseuses synchrones ou métachrones, issues d’une tumeur primitive solide histologiquement prouvée et contrôlée, ont été inclus. Les épidurites métastatiques de gradesupérieur à1B étaient exclues. L’incidence sans récidive locale, la survie globale la survie sans progression, l’incidence de la progression osseuse, la survie sans événement osseux, la toxicité et la réponse antalgique ont été évaluées.
Quarante-six patients et 52 métastases osseuses ont été traités. Vingt-trois métastases (44,2 %) ont été traitées par irradiation stéréotaxique exclusive et 29 (55,8 %) une association de radiothérapie stéréotaxique et de radiothérapie conformationnelle de fractionnement standard. Le suivi médian était de 22 mois. Cinq récidives locales (9,6 %) ont été observées et l’incidence sans récidive locale était de 95,6 % à 1 an et 92,0 % à 2 ans. La probabilité de survie globale à ans était de 90,8 % à 1 an et 87,4 % à 2 ans. La présence de métastases viscérales (hazard ratio HR : 3,40 1,10–10,50) et un temps écoulé entre le diagnostic initial de la maladie et la radiothérapie stéréotaxique de plus de 30 mois (HR : 0,22 0,06–0,82) étaient des facteurs pronostiques indépendants pour la survie globale. La probabilité de survie sans progression ans était de 66,8 % à 1 an et 30,9 % à 2 ans, avec un temps médian de progression de 18 mois. L’incidence de la progression osseuse était de 27,7 % à 1 an et 55,3 % à 2 ans. En analyse multifactorielle, une histologie de groupe défavorable était associée à une incidence de la progression osseuse plus courte (HR : 3,19 1,32–7,76). La probabilité de survie sans événement osseux était de 93,3 % à 1 an et 78,5 % à deux ans. Le taux de réponse global antalgique était de 75 % (9/12). Aucune toxicité de gradesupérieur ou égal à3 ni aucune myélopathie radio-induites n’ont été observées. Deux patients ont souffert de fractures vertébrales radio-induites asymptomatiques.
La radiothérapie stéréotaxique seule ou associée à une radiothérapie conformationnelle de fractionnement standard est un traitement efficace et bien toléré qui permet l’obtention d’un taux de contrôle local élevé des oligométastases osseuses.
Les modes cognitifs actuels du langage s’intéressent en priorité au traitement des informations dans des réseaux distribués avec certaines zones corticales se comportant comme des nœuds pour gérer ...des fonctions spécifiques, reliés via des structures sous-corticales.
Étudier la connectivité de la région temporale basale en fonction de ses articulations avec le langage.
Des stimulations électriques corticales (SEC) à haute fréquence, ayant l’avantage de produire des perturbations transitoires des fonctions cognitives, ont été utilisées chez des patients présentant une épilepsie pharmaco-résistante et explorés par des électrodes profondes dans le cadre du bilan préopératoire afin de délimiter la zone temporale basale du langage (BTLA). Toujours par des SEC mais à basse fréquence, des mesures de connectivité fonctionnelle et effective ont été réalisées par la technique des potentiels évoqués cortico-corticaux.
Les zones apparentant à la BTLA présentent statistiquement plus des connections notamment avec les structures temporales internes. Le gyrus fusiforme est, en parallèle, fortement impliqué dans des réseaux n’appartenant pas à la BTLA.
La mesure de la connectivité effective couplée à la stimulation corticale fonctionnelle dans l’étude du langage et notamment de la BTLA amène une nouvelle dimension dans la compréhension des articulations entre une zone fonctionnelle et ses connections au-delà de sa localisation anatomique. En plus, des patterns de connectivité spécifiques nous permettent d’avancer des hypothèses concernant les relations du langage avec d’autres processus cognitifs, notamment la mémoire.
Highlights • Postural control in degenerative cervical spine diseases was analyzed. • Posture was analyzed in unperturbed and optokinetic stimulation situations. • Two groups were formed according to ...discal or spondylotic nature of the disease. • Sensorial strategies in posture depended on the type of cervical pathology. • Surgery seemed to reduce visual contribution mostly in patients with spondylosis.
Contribution of deep brain sources on scalp EEG is still under debate. It is particularly true for mesial temporal sources which are deep with an infolded geometry. We analyzed simultaneous ...multi-scale EEG recordings (scalp and intracerebral) to delineate their contribution to scalp EEG. Interictal intracerebral spike networks were classified in 3 distinct categories: solely mesial, mesial as well as neocortical, and solely neocortical. The highest and earliest intracerebral spikes were marked and the corresponding simultaneous intracerebral and scalp electroencephalograms were averaged and characterized. In 7 drug-resistant epileptic patients, 21 intracerebral networks (4048 spikes) were identified. Averaged scalp spikes arising respectively from mesial, mesial plus neocortical and neocortical networks had a 7.1, 36.1 and 10 μV average amplitude. Their scalp electroencephalogram electrical field presented a negativity in the ipsilateral anterior and basal temporal electrodes in all networks and a significant positivity in the fronto-centro-parietal electrodes solely in the mesial plus neocortical and neocortical networks. Topographic consistency test proved the consistency of scalp electroencephalogram maps and hierarchical clustering clearly differentiated them. We have thus shown for the first time that mesial temporal sources (i) contribute to scalp electroencephalogram but (ii) cannot be spontaneously visible (mean SNR: −2.1 dB) on scalp at the single trial level.
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