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Biomedical subjects

J Touchon

Publications and source records attributed to J Touchon.

At least 73 records · Page 4Linked to original sources
PubMed1986

[Regional cerebral blood flow in partial complex epilepsy with and without the presence of lesions].

Regional cerebral blood flow (r CBF) was measured by the I.V. 133 Xenon method and use of 27 detectors in 91 patients with complex partial epilepsy in interictal periods (at least 48 h over a complex partial seizure). Some were also examined less than 48 h before or after seizures. All were studied with ictal and interictal electroencephalography (EEG), polysomnography, computed tomography (CT), some had nuclear magnetic resonance scans (MR). The blood flow values were compared with a group of a 20 normal subjects matching for age. A significant decrease of r CBF ranged from 15% to 25% was found in the temporal region in three groups of epileptic patients: with repeated normal CT scans and lateralized EEG abnormalities (N = 46); with cortical atrophy in CT scan (N = 12); with neurosurgical focal lesions on CT and or MR scans glioma, arteriovenous malformation) (N = 10). r CBF was normal or decreased by less than 15% in the other regions of the brain. Patients with repeated normal CT scans and bilateral EEG abnormalities either asynchronous or alternatively observed in the right side or left side on waking EEG or during NREM sleep and REM sleep, did not show reduction in r CBF. In a previous study, r CBF distribution was also found normal during interictal phase in patients with primary generalized epilepsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[EEG abnormalities of late-onset epilepsy].

Interictal EEG abnormalities were evaluated in 111 epileptic patients in which the first seizure occurred after the age of 18 years. Standard day-time EEG tracings performed prior to and after antiepileptic treatment, and all-night recordings were investigated. Before treatment, waking EEG was normal in 54% of patients. The percentage of normal sleep EEG recordings was only 28.6%. Focal EEG abnormalities were found in 39% of day-time recordings and in 48.6% of sleep recordings, while the percentage of generalized epileptic discharges observed was respectively 7 and 22.8. When considering the category of epilepsy and the etiology, it appears that the primary and secondary generalization of epileptic discharges is reduced with age.

Adolescent↗
PubMed1986

Daytime sleep characteristics and their relationships with night sleep in the narcoleptic patient.

Thirty-six narcoleptic patients with overwhelming sleep episodes, cataplexy, and sleep onset REM (SOREM) episodes were recorded for 34 continuous hours in the laboratory starting at 2200 h and ending at 0800 h a day and a half later. There were 94 SOREM and 60 sleep onset NREM (SONREM) episodes. While SONREM episodes were evenly distributed across daytime, SOREM episodes peaked between 0800 and 1000, 1200 and 1400, and 1600 and 1800 h. The ratio of SOREM to SONREM episodes was at its highest level between 1200 and 1400 h. Correlation coefficients between night 1 and night 2 for total sleep time (TST) and percentages of sleep stages were all positive and significant, whereas between daytime and each night, they were significant for percentages of stages 1, 2, and REM. Sleep-stage distribution across the last 24 h of continuous recording indicated that although TST levels were higher than that typical of normal subjects, REM sleep and slow wave sleep followed the same circadian distribution as that observed in normal subjects. The results are interpreted as evidence that the daytime sleep of narcoleptic patients is modified, similar to their night sleep, and that SOREM episodes are influenced by a time-of-day effect which culminates between 1200 and 1400 h.

Adolescent↗
PubMed1986

Regional cerebral blood flow during interictal state: differences between temporal lobe epilepsy and primary generalized epilepsy.

Regional cerebral blood flow (rCBF) was investigated during interictal state by 133Xenon intravenous clearance technique in two groups of epileptic patients: group I (n = 28) having partial complex seizures (temporal lobe epilepsy); group II (n = 14) having generalized seizures (primary generalized epilepsy). Mean hemispheric CBF was decreased in group I and unchanged in group II compared to normal controls. Modifications in rCBF pattern were observed in group I but not in group II. A marked hypoperfusion of one temporal region was found in patients from group I showing a unilateral and fixed epileptic focus. Hypoperfusion of other cerebral areas at a distance from the epileptic focus was greater for patients with a left epileptic focus than for those with a right epileptic focus. Patients with the same severity of disease and bilateral and variable foci had no significant modification of mean hemispheric CBF and rCBF distribution. These observations indicate that interictal investigations of rCBF may be of interest for a differential classification of epilepsy.

Adolescent↗
PubMed1986

Correlations between cerebral grey matter flow and hepatic histology in alcoholism.

Thirty alcoholic with a mean age of 44.8 years were examined with the intravenous 133-Xenon method for measurements of regional cerebral flow (rCBF). The results were related to liver histology and hepatic function tests. While there exists no correlation between the rCBF values and hepatic function tests, an important connection between rCBF decrease and the severity of the histological liver analysis is shown. It is suggested that the hepatic biopsy is a good criterion for the long-term evaluation of alcohol impact upon the brain of a given individual and some physiopathological mechanism are discussed.

Adult↗
PubMed1986

Clinical and neuropsychological rating scales for differential diagnosis of dementias.

Clinical and neuropsychological rating scales were used in two studies of patients. The first one included 20 patients with progressive dementia and was divided into two groups according to their ischemic score evaluation and ancillary examinations (EEG, cerebral evoked potentials, CT scan, Doppler, xenon-133 clearance). The first group consisted of 10 patients with primary degenerative dementia of the Alzheimer type (SDAT) (n = 10). The second group included 10 patients with dementia caused by multi-infarction (MID). The second study included 18 patients with a confusional state, examined repeatedly for 1-6 months afterwards. The clinical and neuropsychological procedure consisted of a multi-dimensional assessment including 8 rating scales. A significant difference was found in the overall clinical and neuropsychological profile of patients with SDAT and MID. Cognitive functions were homogeneously impaired in the group of SDAT patients and heterogeneously in the group of MID patients. In chronic confusional states the overall profile was similar to that of the group of MID patients. Further reassessment showed a normalization in 9 patients, a vascular MID profile in 6 cases, an SDAT profile in 3 cases, and an undifferentiated one in 2 cases. Reversibility of the confusional state might be predicted at the onset of the cognitive disorder by history-taking and evaluation of the ischemic score.

Aged↗
PubMed1985

[Diminished regional cerebral blood flow during the intercritical period in temporal lobe epilepsy].

Hemisphere and regional cerebral blood flow (CBF) were determined during interictal periods by intravenous Xenon 133 in 43 patients considered to have "temporal" epilepsy and presenting complex partial attacks with altered consciousness and lateralized EEG anomalies predominant in the temporal region. Brain scans were normal in all cases. Three subgroups were differentiated according to EEG and polygraphic examinations during sleep; temporal epilepsy with left or right EEG anomalies, with asynchronous bilateral EEG anomalies, with alternating labile unilateral EEG anomalies. Measurements of CBF were compared with those of normal subjects (n = 13) of comparable age and with those of epileptic patients with cerebral lesions on CT scan (n = 4). In epileptics with left EEG anomalies CBF was diminished by about 25 p. 100 in the left temporal region and from 15 to 22 p. 100 in other regions of the ipsi- and contralateral hemisphere. In epileptics with right EEG anomalies CBF was diminished by 20 p. 100 in the right temporal region but not on the left. CBF in the third group was comparable to that of normal subjects. In epileptics with abnormal CT scans the reduction in CBF could be correlated with EEG and CT scan findings. Studies were also conducted to determine variations in reactivity to CO2 in the areas with reduced flow, during ictal and interictal periods. Results emphasize the value of CBF measurements for investigation of epileptic foci. The importance of areas of reduced blood flow as a parameter of severity and course is discussed, as well as their pathophysiological significance.

Adolescent↗
PubMed1984

[Brain stem auditory evoked potentials in "alcoholic epilepsy"].

BAEPs were studied in a group of subjects suffering from 'alcoholic epilepsy.' Results were then compared with data from normal subjects and chronic alcoholics without epilepsy. The latency for peak V and the inter-peak latencies (I-III, III-V, I-V) were significantly longer in the 'alcoholic epilepsy' group than in the control group. This increase of neural transmission time in the brain-stem auditory pathways was less important in the 'chronic alcoholics without epilepsy' group than in the alcoholic epilepsy group.

Adult↗
PubMed1983

[Auditory evoked brain stem potentials and ischemic pathology of the vertebrobasilar system].

Brain stem auditory evoked potentials in subjects with transient ischemic attacks of the vertebro-basilar system and a high "vascular index" (based on clinical and paraclinical criteria) show an abnormal elevation of the intervals I-III, III-V and I-V compared to the values obtained in normal subjects under the same conditions. In subjects with functional signs of vertebro-basilar ischemic attacks without an abnormal "vascular index", the intervals I-III and I-V are slightly raised, however the interval III-V is not significantly modified. These results stress the value of recording early auditory evoked potentials in the objective evaluation of transient ischemic attacks of the vertebro-basilar system.

Adult↗
PubMed1981

[All-night polygraphic recordings in the child with suspected epileptic seizures, in spite of normal routine and post-sleep deprivation EEGs (author's transl)].

Normal standard EEGs and normal or borderline EEGs after sleep deprivation in children with one or several suspected epileptic seizures are relatively frequent. All-night polygraphic recordings were performed on 31 children, aged 3-11, who fall into this category, in order to demonstrate epileptiform activity. Three of the recordings were normal, whereas 8 were borderline and 20 showed unequivocal epileptiform activity. The rate of sleep activation is discussed according to the types of epilepsies, the age at the first seizure, the frequency of the seizures, and the position of the seizures within the sleep-waking cycle.

Child↗
PubMed1981

[Electrophysiological aspects of alcoholic epilepsy (author's transl)].

Two types of neurophysiological investigations (standard EEG and polygraphic recording of sleep) were performed on a group of subjects suffering from 'alcoholic epilepsy'. Results were then compared with data from normal subjects and chronic alcoholics without epilepsy. Epileptic patterns on standard EEG are rare. They are increased by sleep. Both the alteration of basal activity in wakefulness and the organization of sleep point to a dysfunction of the CNS. The role of chronic alcoholic intoxication in epileptic seizures could be explained through the slowly decreasing biochemical cerebral action after withdrawal, rather than by a local or diffuse effect in the CNS level.

Adult↗
PubMedDate not supplied

Subclinical cognitive impairment: epidemiology and clinical characteristics.

Subclinical cognitive impairment is commonly reported in elderly populations, but its clinical significance is largely undetermined. It is commonly perceived as a normal feature of the aging process or a separate nosological entity. The clinical status of this disorder is explored herein by reference to longitudinal observations. It is concluded that persons with subclinical cognitive impairment constitute a highly heterogeneous group. There is an elevated risk in this group for senile dementia, with an estimated 18% incidence rate over 3 years, but in the majority of cases, this problem is more commonly associated with depressive symptomatology and physical illness. Only 13% of persons with recent observable change in cognitive functioning appear to have a totally benign and transient syndrome. Caution should be exercised in applying single unifying nosological entities such as age-associated memory impairment to this group of the elderly.

Aged↗
PubMedDate not supplied

The relationship between apolipoprotein E4 and lipid metabolism is impaired in Alzheimer's disease.

BACKGROUND: Human apolipoprotein (Apo) E4 (ApoE4) is an important determinant of lipid metabolism and cell-to-cell cholesterol transport. It is also a major genetic risk factor for both vascular disease and familial and sporadic late-onset Alzheimer's disease (AD). Since vascular pathology could dramatically reduce neuronal reserve capacity, a biological chain of events between ApoE4, hypercholesterolemia and AD has been postulated. The aim of the present study is to explore the relationship between lipid metabolism and ApoE isoforms in a large series of elderly subjects in relation to the presence or absence of AD. METHODS: Of 332 referrals to a neurology clinic specializing in memory disorders, 146 were given a diagnosis of AD (age, mean +/- SD 76 +/- 13.1 years, 64.4% women) according to DSM-IIIR criteria. One hundred and seventy-six subjects were included as controls (age 80 +/- 5.6 years, 58% women). The ApoE phenotype was determined by the isoelectrofocalization method, cholesterol, triglycerides, phospholipids, ApoA and ApoB were determined by routine chemistry. FINDINGS: A significant association was observed between the E4 allele and AD (chi2 = 13, p < 0.001) only below age 80. In the control group, cholesterol levels were found to be significantly higher in men but not in women with an E4 allele (6.35 +/- 1.3 mmol/l) as opposed to those without (5.8 +/- 1.2 mmol/l). ApoB levels were also found to be higher in the presence of ApoE4, with no gender effect. Within the AD group no significant relationship was found between ApoE4 and cholesterol levels (mean 6.05 +/- 0.9 mmol/l in E4-AD subjects versus 5.8 +/- 1.21 mmol/l in non-E4-AD subjects). Similar observations were made in relation to triglycerides and phospholipids. INTERPRETATION: Our results demonstrate the disappearance of the ApoE4-raising effect on serum cholesterol, triglyceride and phospholipid levels in AD suggesting a more complex relationship between AD and lipid metabolism than has previously been supposed. This lipid abnormality may further contribute to the progression of AD.

Aged↗
PubMedDate not supplied

[Sleep induction].

Physiological sleep induction is a fragile phenomenon which may be altered by environmental factors and various somatic and psychiatric disorders. Therefore sleep induction disorder is a common component of different types of insomnia, including sleep-onset insomnia and to a lesser degree multiple awakenings insomnia and early morning awakening insomnia. The treatment of sleep induction disorders is difficult and requires a precise analysis of the disorder and its aetiological factors. Specific treatment of aetiological factors is more likely to be efficacious in the long term than pharmacological sleep induction (eg: psychiatric disorders, sleep apnea syndrome, restless leg syndrome, periodic movements in sleep, disorders of the sleep-wake schedule...) when the use of hypnotic drugs is necessary agents not altering sleep architecture are preferred. Non-pharmacological methods could be used to induce sleep because they provide a better long term efficacy: sleep hygiene, relaxation techniques, biofeedback technique, psychotherapeutic techniques. Recently, some authors stress the use of treatment by restriction of time in bed and stimulus control treatment.

Anti-Anxiety Agents↗
PubMedDate not supplied

[Comparison of 6 different methods for lorazepam withdrawal. A controlled study, hydroxyzine versus placebo].

PATIENTS AND METHODS: 154 outpatients with generalized anxiety (DSM III-R criteria), followed by general practitioners, gave an informed written consent to participate in this multicenter, randomized, placebo controlled study previously approved by a legal ethic committee (CCPPRB). The patients had to be long term consumers (at least 3 months) of 2 mg daily of lorazepam and were withdrawn using transiently an antihistaminic anxiolytic (hydroxyzine or placebo TAD) according to 6 different procedures defining 6 parallel groups: hydroxyzine 50 mg, abrupt or progressive withdrawal; hydroxyzine 25 mg, abrupt or progressive withdrawal; placebo, abrupt or progressive withdrawal. Following this 4 week-period of withdrawal, the patients were without any treatment for a post-study follow up 2 month-period. Clinical evaluations for anxiety (HARS, Zung), sleep (Spiegel), BZD withdrawal syndrome (Tyrer), adverse reactions and clinical global impression (CGI) were performed at D0, D7, D14, D28, D35 and D88. Investigators opinion and patients attitude towards BZD were collected at D88. STATISTICAL ANALYSIS: Analysis of variance for quantitative variables and chi square test for qualitative or ordinal variables. RESULTS: Whatever abrupt or progressive, with or without hydroxyzine support, using half or full dosage, lorazepam withdrawal proved to be feasible even after a long term BZD treatment (mean = 64 months +/- 60). GPs opinion (72% satisfied: D35; 78% satisfied: D88) is satisfying but patients attitude (at D88: 54% patients desired to be regiven a tranquilizer, 31% patients occasionally had a BZD and 22% formally demanded a prescription of BZD) is more questionable. Despite a high initial level of anxiety under lorazepam (HARS = 21 +/- 10 at D0), after a one-month period of withdrawal (under placebo or hydroxyzine) followed by a 2 month-period without any treatment, 75% patients were totally free of any drug and their level of anxiety was significantly decreased (D88: HARS = 12 +/- 9). Progressive withdrawal appeared preferable if compared to abrupt since the number of drop outs between D28 and D88 was less important and the procedure judged more favourably by the patients. Levels of anxiety significantly decreased in both the groups (progressive and abrupt) but sleep parameters and number of withdrawal symptoms between D7 and D28 were improved only in abrupt withdrawal group (p < 0.0001). Considering hydroxyzine, 2 patients dropped out between D0 and D28 in the group hydroxyzine 25 mg, 6 patients in the group 50 mg and 5 patients in the group placebo. Levels of anxiety (HARS et Zung) were significantly improved in hydroxyzine 50 mg group (p < 0.007) and in hydroxyzine 25 mg group (p < 0.012) but not in placebo group. Withdrawal symptoms (Tyrer) between D0 and D28 were improved only in hydroxyzine 50 mg group and the number of side effects was significantly improved in both the hydroxyzine (25 et 50 mg) groups but not in placebo group. However, no significant difference was found between the 3 groups. Daytime sleepiness is more frequent in hydroxyzine 50 mg group. DISCUSSION: These results proved a significant improvement of anxiety, a decrease of side effects in both the groups treated with hydroxyzine and a reduction of withdrawal symptomatology in hydroxyzine 50 mg group. When a patient is engaged to be withdrawn from of a lorazepam long term treatment, it can therefore be proposed as a support a transient prescription of hydroxyzine 25 mg TAD to markedly anxious patients and of hydroxyzine 50 mg TAD to patients presenting a withdrawal symptomatology.

Adolescent↗