Unusual electronmicroscopic changes in valproate-associated liver failure.
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Adult↗
Biomedical subjects
D Caparros-Lefebvre
Publications and source records attributed to D Caparros-Lefebvre.
Unilateral loss of facial flushing and sweating with contralateral anhidrosis: harlequin syndrome or Adie's syndrome?
A 45-year-old woman presented with a 10 year history of asymmetrical facial flushing and sweating after exertion or in hot weather. During these episodes the right side of her face remained dry and white, while the left side normally flushed. Sweating was impaired on the left side in the limbs and trunk. She also had areflexia in the lower limbs and slow pupillary reactions to light and darkness, as seen in Adie's syndrome. The topography of the sweating disorder suggested that the lesion involved the sympathetic pathways at the level of spinal cord. The relationship with the harlequin syndrome and related disorders is discussed.
Adie Syndrome↗
Chronic thalamic stimulation improves tremor and levodopa induced dyskinesias in Parkinson's disease.
Chronic thalamic stimulation was performed in 10 Parkinsonian patients with disabling tremor and poor response to drug therapy. During the stereotactic procedure, an electrode was introduced in the ventralis intermediate nucleus of the thalamus. Test stimulation was performed during the intra-operative procedure and a few days after surgery using an external stimulator. When tremor was obviously reduced by thalamic stimulation, an internal stimulator was implanted under the clavicle. Tremor was initially suppressed in all cases and reappeared whenever stimulation was stopped. Patients were followed for 22 to 34 months. Tremor was controlled in eight cases but reappeared after three months in two cases. Levodopa induced dyskinesias were observed before electrode implantation in 5 cases. They consisted of peak-dose choreic or ballistic dyskinesias in 4 cases and biphasic dystonic dyskinesias in 3 cases. Peak-dose dyskinesias were greatly improved or suppressed in all cases. Biphasic dyskinesias were improved in 2 cases. Thalamic stimulation was well tolerated. Mild dystonic hand posture related to the deep brain stimulation was observed in one case. No neuropsychological side-effects were noted. Thalamic stimulation could prove to be an adequate treatment for resistant tremor and levodopa induced dyskinesias.
Aged↗
[Subcutaneous apomorphine in major motor oscillations of parkinsonian patients].
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Aged↗
Control of tremor and involuntary movement disorders by chronic stereotactic stimulation of the ventral intermediate thalamic nucleus.
The authors report on the long-term results of chronic stereotactic stimulation of the ventralis intermedius thalamic nucleus performed in 14 cases of disabling and intractable tremor. There were 10 patients with parkinsonian tremor and four with essential tremor. Three of the 10 parkinsonian patients had previously undergone contralateral thalamotomy. Tremor was assessed by clinical evaluation, surface electromyography, accelerometer, and videotape recordings before and after stimulation. The deep-brain electrode was implanted in the ventralis intermedius nucleus according to stereotactic procedure and connected to a subcutaneous pulse generator after a stimulation test period. Tremor suppression or reduction was obtained in all cases with high-frequency (130 Hz) stimulation. Marked functional improvement was maintained in 11 patients with a mean follow-up interval of 17 months. Levodopa-induced dyskinesias observed in five parkinsonian patients prior to surgery were improved or suppressed in four cases by thalamic stimulation. Stimulation was continued during the day and stopped at night in eight cases. Six patients were stimulated night and day to avoid a rebound effect which appeared as soon as the pulse generator was stopped. The only side effects were hand tonic posture in one case and persistent paresthesia in another case. The mechanism of action of this attractive treatment may be a functional alteration of the thalamic discharging area. The authors conclude that this technique is a good alternative to thalamotomy, especially when the risks of high-frequency coagulation are severe in frail and older patients.
Adult↗
[Novel possibilities for treatment of parkinsonian tremor and other abnormal movements by stimulation of the nucleus ventralis intermedius thalami].
Chronic thalamic stereotactic stimulation has been performed in 22 patients with disabling tremor and poor response to drug therapy: 17 parkinsonian tremors and 5 essential tremors. Our first results are presented with a mean follow-up of 26 months. Parkinsonian tremors 17 = complete disappearance: 12, clear improvement: 5. Essential tremors 5 = complete disappearance: 3, clear improvement: 1, failure 1 cured by thalamotomy. Choreic or ballistic dyskinesias 7 = complete disappearance: 5, clear improvements: 2. Dystonic dyskinesias 3 = complete disappearance: 2, failure: 1. This new stereotactic procedure permits to control easily not only tremor but also L-Dopa induced dyskinesias: choreic or ballistic dyskinesias and biphasic dystonic dyskinesias. The place of this surgical treatment among the other therapeutic possibilities is discussed.
Electric Stimulation Therapy↗
[Neuropsychological evaluation before and after thalamic stimulation in 9 patients with Parkinson disease].
Chronic thalamic-VIM stimulation was performed in 9 parkinsonian patients with disabling tremor and poor response to drugs. Neuropsychological assessment was performed before and after deep brain electrode implantation and stimulation. Mild cognitive disorders were observed prior to thalamic implantation. Neuropsychological testing failed to show intellectual function worsening after implantation and stimulation. We conclude that thalamic stimulation could be an appropriate treatment of untractable tremor as this could provide less neuropsychological side-effects than thalamotomy, especially in Parkinson's disease.
Aged↗
[Thalamocapsular metastasis of muco-epidermoid adenocarcinoma of the parotid gland].
A 58 years woman with muco-epidermitis carcinoma of the left parotid gland treated by parotidectomy and external radiation developed seven years later a left hemianopsia and moria related to thalamo-capsulo-lenticular lesions. Three stereotactic biopsies were performed. Neuropathological examination confirmed a secondary lesion of carcinoma with the same histological features than primary lesion of the parotid. Due to the metastasis location treatment consisted in external radiotherapy guided by stereotactic coordinates.
Adenocarcinoma↗
[Multiple intracranial tuberculomas. Aspects in magnetic resonance imaging and the therapeutic contribution of ofloxacin].
A 38 year old alcoholic patient presented meningitis, loss of consciousness, pneumopathy and multiple cerebral lesions on a CT scan. He improved with ofloxacin and corticosteroid therapy, before the administration of anti-tuberculin treatment. Magnetic resonance imaging was used to follow the course of the lesions once the CT scan had become normal. This case demonstrates the efficacy of ofloxacin against central nervous system tuberculosis.
Adrenal Cortex Hormones↗
[Dacrystic and asystolic epileptic seizures].
A 33-year-man with an encephalopathy of unknown aetiology, had an history of epilepsia for 30 years. Different types of seizures were seen, including grand mal and frontal attacks. Epilepsia was associated with mental retardation and behavioral disorders. At the age of 33, he was admitted for repetitive general convulsions. Epilepticus status lasted for two weeks and improved with vigabatrin et clonazepam. General seizures, frontal motor convulsions with arms and trunk antepulsion, and dacrystic attacks were seen. The latter seemed to be like normal crying because they were accompanied by lacrimation, contorted and mournful facies, and sobbing sounds. One year later, repetitive cardiac arrests occurred during a new epilepticus status. Cardiac arrests, observed on ECG holter lasted 10 to 24 seconds, without cardiac dysfunction. EEG patterns on ECG holter lasted 10 to 24 seconds, without cardiac dysfunction. EEG patterns included theta and delta activity with rhythmic slow wave epileptic activity, predominating on right side, in temporal areas. CT scan was normal. MRI showed right cerebral atrophy, prevailing in the temporo-mesial region, with right temporal horn enlargement. This case report of dacrystic seizures, the first one with MRI study, suggests that temporo-mesial structures of the non-dominant hemisphere may be involved in dacrystic and asystolic attacks.
Adult↗